外科围手术期去氨加压素对出血和血栓形成的影响

Effect of desmopressin on perioperative bleeding and thrombogenesis in surgery of vein varicose

目的评价血管外科静脉曲张手术、泌尿外科手术以及骨科手术围术期应用去氨加压素对围术期出血及术后相关血液检测指标的影响。方法选择2018年1月至2019年7月于中国医学科学院北京协和医院、北京大学肿瘤医院、中国医科大学附属盛京医院、山东省立医院、临沂市人民医院接受大隐静脉曲张手术、泌尿外科手术以及骨科手术患者182例,本研究为前瞻性研究,采用随机数表法将患者分为药物组(n=98)和对照组(n=84)。每组患者按照手术方式不同又分为静脉曲张手术组、骨科手术组及泌尿外科手术组。比较2组血红蛋白、血小板、血清钠、丙氨酸氨基转移酶、血肌酐、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、D-二聚体、纤维蛋白原(Fb)、术后是否发生出血、术中出血量以及术后瘀斑面积变化。采用SPSS 26.0软件进行数据分析。根据数据类型,组间比较分别采用χ^(2)检验、U检验、t检验或Fisher确切概率法。结果术后第1天,药物组患者中静脉曲张手术组及骨科手术组血清钠、静脉曲张手术组APTT及骨科手术组PT,均明显低于对照组,差异均有统计学意义(均P<0.05)。术后第2天,药物组患者中静脉曲张手术组及骨科手术组血清钠、Fb,均明显低于对照组,差异均有统计学意义(均P<0.05)。对照组术后第1,2天血肌酐均比术前降低,差异均有统计学意义(均P<0.05)。其余指标差异无统计学意义。药物组中的静脉曲张手术组术后瘀斑发生率[16(32.7%)]低于对照组[16(41.0%)],且药物组单侧患肢瘀斑面积[0.220cm^(2)(0.155cm^(2),0.580cm^(2))]较对照组[0.315cm2(0.163cm^(2),1.475cm^(2))]小,差异均有统计学意义(均P<0.05)。结论围术期应用去氨加压素可影响相应血液检测指标,有效减少大隐静脉曲张术后瘀斑面积,减少出血和下肢深静脉血栓发生率。

Objective To evaluate the effect of perioperative administration of desmopressin on perioperative bleeding and postoperative blood test indexes in patients receiving varicose vein,urological and orthopedic surgeries.Methods This prospective study randomly enrolled 182 patients who underwent great saphenous varicose vein surgery,or urological or orthopedic surgery in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences,Beijing Cancer Hospital,Shengjing Hospital of China Medical University,Shandong Provincial Hospital,and Linyi Municipal People′s Hospital between January 2018 and July 2019.The patients were randomly divided into desmopressin group(n=98)and control group(n=84),each group being further divided into three subgroups:varicose vein surgery,orthopedic surgery,and urological surgery.The two groups were compared in hemoglobin,platelets,sodium,alanine aminotransferase,serum creatinine,prothrombin time(PT),D-dimer,activated partial thromboplastin time(APTT),fibrinogen(Fb),postoperative hemorrhages,intraoperative bleeding volume and postoperative ecchymosis area.SPSS 26.0 was used for statistical analysis.Data comparison between two groups was performed usingχ^(2)test,U test,t test or Fisher exact test.Results On postoperative day 1,Na level in the varicose vein and orthopedic surgery subgroups,APTT in the varicose surgery subgroup,and PT in the orthopedic surgery subgroup were all lower in the desmopressin group than in the corresponding subgroups of the control group,the differences being statistically significant(P<0.05 for all).On postoperative day 2,Na and Fb in the varicose vein and orthopedic surgery subgroups were lower in the desmopressin group than in those of the control group,the differences being statistically significant(P<0.05 for all).Serum creatinine in the control group was lower on postoperative day 1 and 2 than that before the surgery with statistically significant differences(P<0.05 for all).There was no significant differences in other indexes.Postoperative ecchymosis occurred in more patients in the varicose vein surgery subgroup of the desmopressin group[16(32.7%)]than that of the control group[16(41.0%)],and the single area of ecchymosis in the desmopressin group[0.220 cm(0.155 cm^(2),0.580 cm^(2))]was significantly lower than that in the control group[0.315 cm^(2)(0.163 cm^(2),1.475 cm^(2))],with a statistically significant difference(P<0.05).Conclusion The perioperative use of desmopressin affects blood indexes,effectively reducing the area of postoperative ecchymosis in large saphenous varicose veins and the incidence of bleeding and deep vein thrombosis.