早期应用重组活化凝血因子Ⅶ对重型颅脑外伤的临床疗效

Curative effect of early administration of recombinant activated factor Ⅶ treating patients with severe traumatic brain injury

目的探讨重型颅脑外伤患者早期应用重组活化凝血因子Ⅶ(r FⅦa)的临床疗效。方法40例重型颅脑外伤患者随机分为r FⅦa治疗组和对照组,每组各20例。对治疗组的患者入院时给予r FⅦa40μg/kg静脉注射;治疗组和对照组其他治疗均按颅脑外伤常规治疗进行。比较两组患者入院时(0 h)、治疗后第1 d(24 h)、第3 d(72 h)、1周(168 h)的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白降解产物(FDP)、D-二聚体(D-D)等凝血功能指标的变化,以及术中出血量、迟发性血肿二次手术率、死亡率、术后3个月时的格拉斯哥预后量表(GOS)评分。结果与对照组相比,r FⅦa治疗组能明显减低PT、APTT、FDP、DD异常增高的幅度(均P<0.05)。r FⅦa治疗组的术中出血量[(500±194.3)ml]、术后1周内浓缩红细胞输注量[(1.70±1.72)U]、迟发性血肿二次手术率(15%)和术后3个月内死亡率(15%)均显著低于对照组[(1 030±427.0)ml,(3.61±1.73)U,45%,45%];GOS评分[(3.20±1.28)分]显著高于对照组[(2.35±1.31)分],差异均具有统计学意义(均P<0.05)。结论重型颅脑外伤患者早期应用r FⅦa能改善患者的凝血功能障碍,显著减少患者的迟发性血肿发生率、二次手术率及死亡率;从而提高其临床疗效,改善预后。

Objective To investigate the curative effect of recombinant activated factor Ⅶ （rF Ⅶa） on treating patients with severe traumatic brain injury （TBI）. Methods 40 patients with TBI were randomly divided into the treatment group （n = 20） and the control group （n --20）. Patients in the control group accepted only conventional treatment, while the treatment group accepted an addition dose rFⅦ （40 mg/kg） on admission. The observation window was 168 hours for change of coagulation parameters and adverse events. And the other changes in intraoperative blood loss, reoperation rate, mortality,3 months Glasgow outcome scale （GOS） score were observed. Results Compared with the control group, differences were significant with regard to PT, APTT, FDP, DD （ all P 〈 0.05）. The intraoperative blood loss was （500 ± 194.3 ） ml and （ 1030 ± 427.0） ml, the 168 h concentrated red cell transfusion amount was （ 1.70 ± 1.72） u and （3.61 ± 1.73 ） u, the reoperation rate was 15% （3/20） and 45% （9/20） ,the mortality was 15% （3/20） and 45% （9/20） ,the 3 months GOS score was （3.20 ± 1.28） and （2.35 ± 1.31 ） in the treatment and control group respectively （all P 〈 0.05 ）. Conclusion Early application of rF VII a for patients with TBI can improve blood coagulation function, reduce reoperation rate and mortality, which can improve the clinical efficacy and activity ability of daily living.