神经外科手术应用注射用血凝酶止血的临床效果观察

Clinical effect of Baquting on bleeding control in neurosurgery

目的 观察注射用血凝酶在神经外科手术中局部应用的止血效果及对凝血功能的影响.方法 选取我院诊治的60例神经外科手术患者,美国麻醉医师协会（ASA）分级Ⅰ、Ⅱ级,随机分为用药组30例和空白对照组30例.两组术前一天给予注射用血凝酶2U肌肉注射;术前30 min注射用血凝酶2U静脉注射;术后注射用血凝酶2U静脉注射,每天2次,连续用药3d.用药组术中应用注射用血凝酶4U＋生理盐水10 ml局部喷洒.比较两组患者的手术视野清晰度、手术出血量、术中输血量、术后引流量,并检测术前及术后凝血酶原时间（PT）、部分凝血活酶时间（APTT）、纤维蛋白原（FIB）定量、纤维蛋白原降解产物（FDP）、D-二聚体和血小板计数（PLT）,并于术后进行随访.结果 用药组手术视野有效改善率为70.0％ （21/30）,空白对照组手术视野有效改善例数为0,两组比较差异有统计学意义（P＜0.05）;用药组术中手术出血量[（680.00±95.22） ml],少于空白对照组[（790.00±47.00） ml],两组比较差异有统计学意义（P=0.034）;两组患者术后PLT计数与术前相比均明显减少（P＜0.05或P＜0.01）,但两组间相比差异无统计学意（P＞0.05）.术后随访两组患者术后恢复好,无不良事件发生.结论 注射用血凝酶局部喷洒用于神经外科手术可改善手术术野清晰度,减少手术出血量;不会影响患者凝血功能,不会增加血栓形成的危险.

Objective To investigate the hemostatic effect and influence on coagulation function of hemecongulase during neurosurgical operation.Methods Sixty patients with neurosurgical trauma at American statistical association（ASA） Ⅰ-Ⅱ were randomly divided into hemocoagnlase treatment group （n =30） and control group（n =30）.Both two group were injected Baquting 2U at the day before the operation,30 min before the operation,every two day after the operation and end up 3 d.Treatment group were pedormed with Baqyting 4 U ＋ physiological saline 10 ml topical spraying.The intelligibility of operating region,the volume of intraoperative,the volume of bleeding during the operation,transfusion of blood,postoperative drainage,and drainage tube exelcymosis time were recorded in all the patients.Prothrombin time （PT）,activated partial thromboplastin time （APTT）,fibrinogen level（FIB）,fibrinogen degradation product（FDP） and the two D-dimer and platelet count（PLT） before and after the surgery were also determined.All the patients were postoperatively followed up.Results The intelligibility of operating region was 70.0% （21/30） in the hemocoagnlase treatment group,higher than that in control group （0%,P 〈0.05）.The volume of bleeding during the operation in the hemecoagulase treatment group was （680.00 ± 95.22） ml,significantly fewer than that in the control group（（790.00 ±47.00） ml,P =0.034）.PLT significantly decreased after the surgery in both of the groups compare to that in preoperation （P 〈 0.05 or P 〈 0.01） and no significant difference was seen between two groups （P 〉 0.05）.No severe adverse events were found in both groups.Conclusion Hemocoagulase treatment during the operation can improve the intelligibility of operating region,reduce the volume of bleeding and transfusion of blood,and do not affect the coagulation function in the patients.Therefore,hemocoagulase is a safe and effective hemostatic and through local application during the operation it can improve curative effect.