血友病A患者围手术期凝血因子Ⅷ替代治疗的疗效评价

Efficacy Evaluation of Perioperative Coagulation Factor Ⅷ Replacement Therapy for Hemophilia A Patients with Surgery

目的:回顾性分析血友病A患者围手术期应用凝血因子Ⅷ替代治疗的疗效。方法:收集42例血友病行普外、骨科、泌尿外科及眼科等手术,并在围手术期实施凝血因子Ⅷ替代治疗的血友病病例,统计患者术前、术中、术后血APTT,FⅧ∶C水平、抑制物滴度,以及术后定期随访情况。结果:42例患者使用凝血因子Ⅷ后均手术顺利,其中大型手术术中FⅧ∶C为(63.4±18.1)%,中型手术术中FⅧ∶C为(58.6±11.8)%,小型手术术中FⅧ∶C为(45.2±19.1)%;大型手术术中出血量(295.0±151.3)ml,中型手术术中出血量(78.0±25.2)ml,小型手术术中出血量(16.0±5.5)ml。患者术后无明显出血,伤口愈合良好,且均无特殊不适。结论:血友病A患者围手术期采用凝血因子Ⅷ替代治疗可取得良好的临床效果。

Objective： To retrospectively analyze the efficacy of perioperative coagulation factor Ⅷ（ FⅧ） replacement therapy for hemophilia A patients with surgery. Methods： Totally 42 hemophilia A patients undergoing various surgeries such as general surgery,orthopedic surgery,urologic surgery and ophthalmologic surgery etc were selected and treated with coagulation factor Ⅷ replacement therapy. APTT,the level of FⅧ∶ C and the inhibitor titer were dynamically monitored during the perioperative period,and the followup was investigated after surgery. Results： All the hemophiliacs were with safe perioperative period. For major surgery,FⅧ ∶ C was（ 63. 4 ± 18. 1） %,and（ 58. 6 ± 11. 8） % for medium-sized surgery,and（ 45. 2 ± 19. 1） % for small surgery. The amount of bleeding during operation was 295. 0 ± 151. 3 ml,78. 0 ± 25. 2 ml and 16. 0 ± 5. 5 ml,respectively. There was no obvious bleeding after operation,and the wound healed well without specific discomfort. Conclusion： Hemophiliacs can tolerate various surgeries if enough coagulation factor Ⅷ is used according to the activity level of clotting factor Ⅷ during the perioperative period.