去氨加压素用于鼻窦内镜手术的临床研究

Desmopressin in functional endoscopic sinus surgery

目的 观察去氨加压素 (DDAVP)用于功能性鼻窦内镜手术 (FESS)的效果。方法 择期行FESS的病人 5 9人 ,随机分成治疗组 (n =30 )和对照组 (n =2 9) ,治疗组于麻醉诱导前 30min将DDAVP 0 .3μg/kg用生理盐水稀释到 10 0ml,15min内静滴完毕 ,对照组输入等量生理盐水。测定两组术前和用药后 1h的血小板计数(PLT)、凝血酶原时间 (PT)、部分凝血活酶时间 (APTT)、纤维蛋白原定量 (FIB)、第八因子促凝活性 (FⅧ :C) ;监测两组平均动脉压 (MAP)、心率 (HR) ,计算心率和收缩压的乘积 (RPP) ;记录术中出血量和手术时间 ;据以评价其临床效果。结果 治疗组用药 1h后APTT显著缩短 ,FⅧ :C显著升高 (P <0 .0 5 ) ,术中出血量和手术时间显著少于对照组 (P <0 .0 5 ) ,总有效率为 90 % ,显著高于对照组 (P <0 .0 5 )。结论 DDAVP可明显增强病人的凝血功能 。

Objective To determine the effect of desmopressin acetate (DDAVP) 3 in functional endoscopic sinus surgery (FESS). Methods Fifty-nine patients who underwent by FESS were divided into the control group (n=29) and the DDAVP group (n=30). Thirty minutes before anesthesia, DDAVP 0.3 μg/kg in a 100 ml saline was given intravenously within 15 min into the DDAVP group, and 100 ml saline was given to the control group. The platelet count (PLT), prothrombin time (PT), activated pactiai thrombopilastin time (APTT), fibrinogen (FIB), factor Ⅷ coagulant activity (FⅧ:C), mean arterial pressure (MAP), heart rate (HR), and rate-pressure product (RPP) were measured an hour before the operation and an hour after using DDAVP. The volume of blood loss and the mean operation time were measured, and the clinical effect was evaluated. Results In the DDAVP group, the APTT curtailed and the FⅧ:C increased markedly after DDAVP administration (P< 0.05). The volume of blood loss and the mean operation time were significantly decreased than those in the control group (P< 0.05). The total effective rate was 90%, which was significantly higher than that in the the control group (P< 0.05). Conclusion The administration of DDAVP can effectively increase the hemostatic function to reduce the blood loss in patients during FESS.