重组活化人凝血因子Ⅶ在老年人围术期大出血中的疗效与安全性

The efficacy and safety of recombinant activated factor Ⅶ on uncontrolled perioperative hemorrhage in elderly patients

目的探讨重组活化人凝血因子Ⅶ(rFⅦa)治疗老年外科难控制性大出血患者的临床疗效及安全性。方法回顾性分析北京医院外科重症监护病房(ICU)2004年5月至2018年12月应用rFⅦa成功治疗的27例老年外科围术期难控性大出血患者的病历资料,并总结其应用方法和经验。结果27例患者中23例患者停止出血,痊愈16例,共有11例死亡,总体病死率为40.74%(11/27);其中因出血未得到有效控制而死于出血者4例,故出血病死率为14.81%(4/27);出血控制后死于原发疾病者7例,病死率为25.93%(7/27)。应用rFⅦa后凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶原国际时间(INR)等指标均显著低于用药前,差异均具有统计学意义(Z=-2.197、-3.180、-2.271、-2.803,P=0.028,0.001,0.023、0.005);而应用rFⅦ后患者凝血酶原活动度(AT)显著高于用药前,差异有统计学意义(Z=2.756,P=0.006)。结论针对老年患者,对于外科难控制性大出血在传统措施治疗无效的情况下,应用rFⅦa治疗可取得较好的效果。

Objective To investigate the efficacy and safety of recombinant activated factorⅦ(rFⅦa)on uncontrolled perioperative hemorrhage in elderly patients in surgical intensive care unit(SICU).Methods Clinical data of 27 elderly patients with uncontrolled perioperative hemorrhage treated successfully with rFⅦa in surgery-ICU of our hospital from May 2004 to December 2018 were retrospectively analyzed.And the application method and experience were summarized.Results Of the 27 patients,16 cases were cured,11 cases died,and the total fatality rate was 40.74%(11/27).The bleeding stopped in 23 cases,four cases died of uncontrolled peri-operative hemorrhage,and the hemorrhage-caused fatality rate was 14.81%(4/27).Seven patients died of primary diseases after the control of bleeding,with a fatality rate of 25.93%(7/27).The thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT)and international normalized ratio(INR)were reduced and the prothrombin activity(AT)was increased after versus before the application of rFⅦa(Z=-2.197,-3.180,-2.271,-2.803 and 2.756,P=0.028,0.001,0.023,0.005 and 0.006,respectively).Conclusions rFⅦa has a better effect on uncontrolled peri-operative hemorrhage in elderly patients,when traditional treatments are ineffective.