抑肽酶用于宫颈癌广泛切除术中止血的临床研究

Clinical Study on Hemostatic Effects of Aprotinin During Radical Hysterectomy and Pelvic Lymphadenectomy

目的了解抑肽酶对宫颈癌广泛切除手术患者失血量、异体红细胞需求量、血红蛋白 (Hb)、血小板 (PLT)计数及凝血功能的影响。方法80例宫颈癌ⅠB～ⅡA 期患者随机分为抑肽酶组和止血敏组 ,观察两组患者术中失血量、术后 2 4h盆腔引流量、手术时间、术中术后异体红细胞输注量以及手术开始前、术毕、术后 2 4h、72hHb、红细胞压积 (HcT)、PLT、凝血酶原时间 (PT)、活化部分凝血活酶时间 (APTT)、血浆纤维蛋白原含量 (FIB)变化。结果A组平均失血量、术后 2 4h引流量 ,较B组明显减少 (P <0 .0 1) ;A组手术时间明显缩短、对异体红细胞需求明显减少 (P <0 .0 5 ) ;两组患者术后Hb均明显低于术前水平 ,但术后 2 4h、72hB组较A组更低 (P <0 .0 1) ;PLT在A组无明显变化 ,B组术后各时点均低于术前水平 ;两组PT、APTT、FIB各时点比较无明显差别。结论抑肽酶能明显减少宫颈癌广泛切除术失血量、异体红细胞输注量 。

Objective To study the effects of aprotinin on quantity of blood losses, required volume of allogenic RBC , hemoglobin (Hb) levels, platelet counts and blood coagulative function during radical hysterectomy and pelvic lymphadenectomy. Methods Eighty patients with cervical carcinoma (ⅠB～ⅡA) were divided randomly into two groups : Aprotinin Group and etamsylatum Group. Intra- and postoperative blood losses, amount of drainage from pelvic cavity in 24 hr. after operation, operation time, volume of allogenic RBC required for transfusion, changes of Hb levels, hematocrit, platelet counts, prothrombin time, activated partial thromboplastinogen time (APTT) and plasma fibrinogen content in pre- and postoperative period were recorded and compared between two groups. Results The average blood losses and pelvic cavity drainage in Group A significantly were lower than in Group B (P<0.01);The duration of operation and the volume of allogenic RBC required for transfusion were reduced in Group A as compared with Group B (P<0.05);The postoperative Hb levels in two groups were lower than their preoperative figures , but the Hb levels of Group B at 24 hours and 72 hours after operation were much lower than those of the Group A(P<0.01); No distinct changes of platelet counts before and after operation were observed in Group A, but the postoperative platelet counts in Group B decreased in comparison with those before operation. No prominent differences were noted in the blood coagulative functions between two groups. Conclusions Aprotinin used during radical hysterectomy and pelvic lymphadenectomy can apparently decrease intra- and postoperative blood losses and the volume of allogenic RBC required for transfusion . It doesn't affect the platelet counts and blood coagulative function of the patients.