人凝血酶原复合物对多节段腰椎内固定术围术期的影响

Effect of Human Prothrombin Complex on Perioperative Blood Loss Control and Safety of Multi-segment Lumbar Internal Fixation

目的探讨人凝血酶原复合物对多节段腰椎内固定术围术期失血量控制及安全性。方法将109例拟行多节段腰椎内固定术患者随机分为2组,研究组(57例)手术过程中采用人凝血酶原复合物静脉滴注,对照组(52例)采用常规止血方法。对比2组患者围术期失血量、输血率、血红蛋白(hemoglobin,Hb)、D-二聚体、纤维蛋白原(fibrinogen,FIB)、凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activated partial prothrombin time,APTT)的变化以及并发症的差异。结果研究组术中失血量、术后隐性红细胞丢失量、术后12,48 h内切口引流量、总失血量、术中输血率、术后输血率、总输血率均明显小于对照组(P<0.05或P<0.01)。对照组围术期D-二聚体、FIB水平逐渐降低(P<0.05),PT、APTT水平逐渐增高(P<0.05),而研究组无显著变化。研究组围术期Hb水平高于对照组(P<0.05)。研究组并发症发生率与对照组无统计学差异。结论人凝血酶原复合物可有效控制多节段腰椎内固定术围术期出血,降低输血率,不增加静脉血栓的风险,安全性好。

OBJECTIVE To investigate the control and safety of human prothrombin complex in perioperative blood loss during multi-segment lumbar internal fixation. METHODS One hundred and nine patients with multi-segment lumbar internal fixation were randomly divided into two groups. The study group(57 patients) received intravenous infusion of human prothrombin complex during the operation, and the control group(52 patients) received the same physiological dose brine. Perioperative blood loss, transfusion rate, hemoglobin(Hb), D-dimer, fibrinogen(FIB), prothrombin time(PT), activated partial prothrombin time(APTT) and the complications were compared between the two groups. RESULTS The blood loss, postoperative recessive red blood cell loss, incision drainage volume after 12, 48 h of surgery, total blood loss, intraoperative blood transfusion rate, postoperative blood transfusion rate and total blood transfusion rate were significant lower in the study group than in the control group(P<0.05 or P<0.01). The D-dimer and FIB levels in the control group were gradually decreased(P<0.05), and the levels of PT and APTT were gradually increased(P<0.05), while there was no significant change in the study group. The perioperative Hb level of the study group was higher than that of the control group(P<0.05). There was no significant difference in the complication rate between the study group and the control group. CONCLUSION The human prothrombin complex can effectively control the perioperative hemorrhage of multi-segment lumbar internal fixation, reduce the blood transfusion rate, and does not increase the risk of venous thrombosis, and is safe and reliable.