Hemostatic effect of topical hemocoagulase spray in digestive endoscopy

AIM: To evaluate the hemostatic effect of topical hemocoagulase spray in digestive endoscopy.METHODS: Eighty-nine patients who developed oozing bleeding during endoscopic treatment from September 2014 to October 2014 at Center for Digestive Endoscopy, Tianjin Medical University General Hospital were randomly divided into either a study group(n = 39) or a control group(n = 50). The study group was given topical hemocoagulase spray intraoperatively, while the control group was given traditional 8% norepinephrine spray. Hemostatic efficacy was compared between the two groups. Bleeding site, wound cleanliness and perforation were recorded, and the rates of perforation and late bleeding were compared.RESULTS: Successful hemostasis was achieved in 39(100%) patients of the study group and in 47(94.0%) patients of the control group, and there was no significant difference in the rate of successful hemostasis between the two groups. Compared with the control group, after topical hemocoagulase spray in the study group, the surgical field was clearer, the bleeding site was more easily identified, and the wound was cleaner. There was no significant difference in the rate of perforation between the study and control groups(16.7% vs 35.0%, P = 0.477), but the rates oflate bleeding(0% vs 15.8%, P = 0.048) and overall complications(P = 0.032) were significantly lower in the study group.CONCLUSION: Topical hemocoagulase spray has a definite hemostatic effect for oozing bleeding in digestive endoscopy, and this method is convenient, safe, and reliable. It is expected to become a new method for endoscopic hemostasis.

Hypofibrinogenemia Caused by Hemocoagulase Injection:A Retrospective Study on Clinical Laboratory Findings

Objective Hemocoagulase injection based on the venom of Agkistrodon halys Pallas is widely used in the treatment of hemorrhagic disorders.This study aimed to characterize the clinical laboratory findings of hemocoagulase-induced hypofibrinogenemia as the associated adverse reaction of hemocoagulase injection.Methods Wie retrospectively enrolled 27 in-patients who were treated with hemocoagulase injection for hemoptysis and developed hypofibrinogenemia during the period of January 1,2015 to March 31,2018.Clinical data were collected and investigated,including clinical manifestations,hemostatic and fibrinolytic parameters,dosage of hemocoagulase,the medication time,and the cryoprecipitate blood product infusion.Differences in fibrinogen,D-dimer,and fibrin/fibrinogen degradation products(FDP)before,during,and after the application of hemocoagulase injection were analyzed statistically.Results Plasma fibrinogen level during medication of hemocoagulase injection decreased significantly compared to that before the treatment(F=1.80,P<0.001),with the average decrease of 2.28 g/L(0.63-3.9 g/L).After withdrawal,fibrinogen level increased significantly compared to that during the medication(F=l.20,P<0.001),but was still lower than that before the medication(F=0.59,P=0.03).The D-dimer level and the FDP level after withdrawal decreased significantly compared to the levels during the medication(F=0.83,P=0.002;Wilcoxon-test,Z=-4.54,P<0.001).Spearman's correlation analyses did not find either fibrinogen change during-before the administration or FDP change after-during the administration was associated with the dosage of hemo coagulase(r=-0.17,P=0.40;r=-0.28,P=0.15;respectively)and the time of recovery from hypofibrinogenemia(r=-0.45,P=0.05;r=0.13,P=0.61;respectively).Conclusion Monitoring both clotting and fibrinolysis parameters is essential in the management of hemoptysis patients treated with hemocoagulase injection.Clinicians should be aware of hypofibrinogenemia and consider discontinuation of the administration of hemocoagulase whenever necessary.

Hemocoagulase Injection blood anesthesia in joint operation

Objective:To investigate the role of Hemocoagulase Injection used in the joint operation and the effect on the blood coagulable function.Methods:A total of 60 patients who undergoing joint operation in our hospital were randomly divided into two groups.Experiment group(Group A,n=30)was injected with 2 U Hemocoagulase Injection in 5 min before anesthesia induction.The contrast group(Group B,n=30)was treated with 0.9%normal saline in 5 min before anesthesia induction.Then common anesthesia was given to the two groups of patients.The venous blood was withdrawn for blood routine examination,thrombelastography and coagulable function at the time of pre-inducement, end of operation,and in 6 and 12 h after operation.The change of thrombelastograph and coagulable state were monitored during the whole surgery.And the volume of transfusion and hemorrhage between two groups was contrasted. Results:After the use of Hemocoagulase Injection,the operative time was shortened obviously(P<0.05).The volumes hemorrhage and transfusion was obviously smaller in Group A than in Group B(P<0.01).Hemocoagulase Injection did not influence fibrinogen and thrombelastograph of Group A(P>0.05).Conclusion:Hemocoagulase Injection can reduce the volumes of hemorrhage and transfusion and not influence the coagulable function.It is worth using in the joint operation.

The mechanism of combination with hemocoagulase and pantoprazole in upper gastrointestinal bleeding

Objective:Through the combination with hemocoagulase and pantoprazole on gastrointestinal bleeding, to observe the changes of serum BUN (blood urea nitrogen), LPO (LPO), NO (nitric oxide), TNF-α(TNF alpha), hs-CRP (high sensitivity C reactive protein) and cortisol levels, and to explore the mechanism of combination. Methods:110 cases of upper gastrointestinal bleeding in our hospital from January 2015 to September 2016 were selected and divided into the control group and the observation group, 55 cases for each group. Patients were treated with bed rest, fasting, intravenous nutrition, oxygen, and according to the individual situation actively supplement blood capacity, and the control group were treated with 40 mg intravenous pantoprazole treatment, 2 times/d;the patients in the observation group were treated with 2 kU hemocoagulase injection based on the treatment of control group, 2 times of intravenous injection per day, and all patients were treated for 3 d, and then the BUN, LPO, NO, TNF-α, hs-CRP and cortisol were detected. Results:(1) There were no significantly differences of the serum levels of BUN, LPO, and NO of the two groups before treatment (P>0.05). After treatment, the serum levels the two groups were significantly lower than before treatment, and LPO, BUN, and NO levels in the observation group were significantly better than the control group (P<0.05);(2) There were no significantly differences of the serum levels of TNF-α, hs-CRP, and cortisol of the two groups before treatment (P>0.05). After treatment, the serum levels in the two groups were significantly lower than before treatment, and TNF-α, hs-CRP, and cortisol levels in the observation group were significantly better than the control group (P<0.05). Conclusions:The treatment of patients with combined use of hemocoagulase and pantoprazole on gastrointestinal bleeding, can significantly improve the serum levels of BUN, LPO, NO, TNF-α, hs-CRP and cortisol levels, and further illustrates the synergistic effect of the combination, also shows that the combination of two drugs for patients with upper gastrointestinal bleeding can improve the symptoms of hemorrhage, reduce inflammation and stress, and improve the treatment effect.

Risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding

BACKGROUND With the widespread use of hemocoagulase in patients with gastrointestinal bleeding,clinicians have become increasingly concerned about coagulation dis-orders associated with this medication.Risk factors for hypofibrinogenemia asso-ciated with hemocoagulase are poorly understood.AIM To determine risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding.METHODS We performed a retrospective analysis of the medical documentation of hospit-alized patients treated with hemocoagulase for gastrointestinal bleeding.Hypofib-rinogenemia was defined as a decrease in plasma fibrinogen concentration to less than 2.0 g/L.The included patients were divided into two groups:acquired hypofibrinogenemia group and non-hypofibrinogenemia group.We used logistic regression analysis to identify potential risk factors and established risk assess-RESULTS There were 36 patients in the acquired hypofibrinogenemia group and 73 patients in the non-hypofibrinogenemia group.The hypofibrinogenemia group showed higher rates of intensive care unit admissions(P=0.021),more female patients(P=0.005),higher in-hospital mortality(P=0.027),larger hemocoagulase doses(P=0.026),more Packed Red Cells transfusions(P=0.024),and lower baseline fibrinogen levels(P<0.000).Binary logistic regression was employed to examine the risk factors associated with acquired hypofibrinogenemia.The analysis revealed that baseline fibrinogen[odds ratio(OR)0.252,95%CI:0.137-0.464,P<0.000],total hemocoagulase doses(OR 1.074,95%CI:1.015-1.137,P=0.014),and female gender(OR 2.856,95%CI:1.015–8.037,P=0.047)were statist-ically significant risk factors.CONCLUSION Higher doses of total hemocoagulase,female gender,and a lower baseline fibrinogen level were risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding.

Nasopore鼻腔局部联合注射血凝酶在鼻内镜术后止血效果的观察

目的:采用双盲随机对照临床试验比较功能性鼻内镜术后术腔Nasopore联合注射血凝酶和Nasopore联合生理盐水鼻腔填塞的止血效果。方法:选择确诊为慢性鼻-鼻窦炎需行功能性鼻内镜手术患者68例,随机分为实验组40例和对照组28例。实验组术后给予Nasopore+注射血凝酶填塞(注射血凝酶均使用1U,使用前将其溶解于0.5ml生理盐水中),术毕将溶解有注射血凝酶的生理盐水注入已填入鼻腔的Nasopore中;对照组术后给予纳吸绵填塞,术毕将0.5ml生理盐水注入已填入鼻腔的Nasopore中。通过患者术后VAS评分比较两组在功能性鼻内镜手术后出血效果的差异。结果:对照组术后6h鼻出血VAS评分分别与同组术后1、2、3d比较,差异有统计学意义(P<0.05);实验组术后6h的鼻出血VAS评分分别与同时段对照组比较,差异有统计学意义(P<0.05)。结论:功能性鼻内镜手术后使用Nasopore作为鼻腔填塞物联合局部使用注射血凝酶,可以有效减少术后6h内的出血。

A multicenter, phase III trial of hemocoagulase Agkistrodon： hemostasis, coagulation, and safety in patients undergoing abdominal surgery

Background Hemocoagulase Agkistrodon for injection is a single component thrombin which has passed phases I and II clinical trials. The purpose of this phase III clinical trial was to evaluate the effect of Hemocoagulase Agkistrodon on hemostasis and coagulation in abdominal skin and subcutaneous incisions and to assess the safety of this agent in surgical patients. Methods This is a phase III, prospective, randomized, double-blind, and controlled multicenter clinical trial including 432 consecutive patients randomized into either a study group （injected with hemocoagulase Agkistrodon at 2 U, n=-324） or a control group （injected with hemocoagulase Atrox, n=108）. The hemostatic time, hemorrhagic volume, hemorrhagic volume per unit area, blood coagulation, and adverse events were measured and compared between the two groups. Results The mean hemostatic time in the study group was （36.8±18.7） seconds; the hemorrhagic volume was （3.77±3.93） g; and the hemorrhagic volume per unit area was （0.091±0.125） g/cm2. In the control group, the corresponding values were （38.1±19.7） seconds, （4.00±4.75） g, and （0.095±0.101） g/cm2, respectively. No significant difference in values existed between the two groups （P 〉0.05）. Blood coagulation results and hepatic and renal function were also similar between the two groups. Adverse events were reported in two cases, but were deemed non-drug-related. Conclusions Hemocoagulase Agkistrodon has good hemostatic and coagulative function and is safe for the use of arresting capillary hemorrhage that occurs while incising the abdomen during surgery.

Study on the anaphylactic shock induced by hemocoagulase for injection based on logistic analysis

In the present study, we aimed to explore the influencing factors of anaphylactic shock caused by hemocoagulase for injection and to provide a scientific basis for clinical safe medication. The cases reports on the adverse reactions induced by hemocoagulase for injection were collected in Chinese and foreign literatures. The clinical characteristics and influencing factors of anaphylactic shock induced by hemocoagulase for injection were evaluated by logistic regression analysis. In this study, 87 articles including 108 cases(68 cases of anaphylactic shock) were collected. Univariate logistic regression indicated that allergic constitution, daily dose, combined anesthesia, first drug delivery, post-dose time and course of treatment were positively associated with the incidence of anaphylactic shock caused by hemocoagulase for injection(P<0.05). The six above-mentioned factors were included in the multivariate logistic stepwise regression analysis to exclude the effects of confounding factors, and the results suggested that allergic constitution(P = 0.048, OR = 8.242), combined anesthesia(P = 0.024, OR = 22.675) and post-dose time(P = 0.006, OR = 20.255) were associated with the incidence of anaphylactic shock caused by hemocoagulase for injection. The clinicians should pay much more attention to risk factors that may cause anaphylactic shock, such as allergic constitution, combined anesthesia and post-dose time. The clinical pharmacists should strengthen pharmaceutical monitoring and improve the safety of medication.

血凝酶用于多发性创伤患者院前急救的价值分析

目的探讨血凝酶用于多发性创伤患者院前急救的价值。方法选取2019年4月至2022年4月北京急救中心收治的104例多发性创伤患者作为研究对象,根据患者是否应用血凝酶分为观察组(常规院前急救并应用血凝酶治疗,n=52)与对照组(常规院前急救治疗,n=52)。比较2组患者的止血时间、平均出血量、单位面积出血,比较2组患者治疗前后的血红蛋白(Hb)、红细胞压积(HCT)、血小板聚集率(PAR)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、抗凝血酶Ⅲ(AT-Ⅲ)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制剂-1(PAI-1),比较2组患者的并发症、不良反应。结果观察组止血时间、平均出血量、单位面积出血均少于对照组(P<0.05);治疗后2组Hb、HCT、PAR水平低于治疗前,观察组高于对照组(P<0.05);2组患者治疗前后,PT、APTT、FIB、D-D、PAI-1、AT-Ⅲ、t-PA水平比较差异无统计学意义(P>0.05)。治疗后,2组患者并发症总发生率比较差异无统计学意义(P>0.05),观察组病死率低于对照组(P<0.05);观察组不良反应发生率为5.77%,对照组不良反应发生率为0,差异无统计学意义(χ^(2)=3.089,P=0.079)。结论多发性创伤患者院前急救应用血凝酶可减少出血量,对患者的凝血和纤维蛋白溶解功能无影响,安全性良好,有利于患者预后的改善。

以血凝酶为例的药品不良反应自动监测反馈系统体温异常数据分析

目的评价药品不良反应(ADR)自动监测反馈系统监测血凝酶致体温异常ADR的准确性,为建立基于自动监测反馈系统的血凝酶体温异常ADR监测方案提供参考。方法采用回顾性研究方法,提取医院ADR自动监测反馈系统2020年9月1日至2021年8月31日监测到的注射用尖吻蝮蛇血凝酶、注射用矛头蝮蛇血凝酶、注射用白眉蛇毒血凝酶致体温异常的ADR报告2434份(涉及患者2434例),以及该时段医院使用血凝酶的11602例患者的临床数据,以血凝酶药品说明书中的标准值作为该药ADR的判断标准,对数据进行多层次统计与分析,评价ADR自动监测反馈系统监测的准确性,并提出改进方案。结果ADR自动监测反馈系统监测到的上述3种血凝酶体温异常ADR发生率分别为19.05%,32.31%,17.51%,与设定的标准值存在较大差异;一过性低热(≤37.5℃)且无不适症状的发生率分别为64.46%,54.45%,73.86%,占比均较高;3种血凝酶引起体温异常ADR患者的年龄均存在显著差异(P<0.01);神经外科手术患者和肿瘤患者该ADR的判断不适合自动监测,其他患者的血凝酶单药引起中热、高热(>38℃)ADR的发生率分别为0.22%,0.20%,0.03%,与药品说明书中ADR发生率标准值接近。结论利用ADR自动监测反馈系统监测血凝酶单药引起的体温异常ADR发生率准确、快速,能较好地监测到一过性低热且无临床不适症状的ADR,漏报较少,但神经外科手术患者和肿瘤患者需药师结合临床判断。

注射用尖吻蝮蛇血凝酶在手术创面止血中的有效性及安全性的系统评价

目的:系统评价注射用尖吻蝮蛇血凝酶在手术创面止血中的有效性及安全性。方法:计算机检索PubMed、the Cochrane Library、Embase、中国知网、万方数据库和中国生物医学文献数据库,检索时间为建库至2023年3月,收集注射用尖吻蝮蛇血凝酶用于手术创面止血的随机对照试验(RCT,研究组干预措施为注射用尖吻蝮蛇血凝酶,对照组为安慰剂或空白对照),中文数据库中限定期刊为中国科技论文核心期刊,英文数据库中不限制期刊。由2名研究者对文献进行筛选、提取及偏倚风险评估,使用RevMan 5.3软件进行Meta分析。结果:共纳入19项RCT研究,包括1 384例患者,其中研究组患者716例,对照组患者668例。Meta分析结果显示,有效性方面,研究组方案降低术中出血量(MD=-65.71,95%CI=-81.99~-49.43,P<0.000 01)、缩短止血时间(MD=-27.25,95%CI=-36.73~-17.77,P<0.000 01)的效果优于对照组,差异均有统计学意义;在安全性方面,与对照组比较,研究组患者24 h后纤维蛋白原水平有一定的降低趋势,24 h后凝血酶原时间有一定的缩短趋势,但差异均无统计学意义(P>0.05)。结论:现有证据表明,注射用尖吻蝮蛇血凝酶针对手术创面止血具有良好的效果及安全性。因当前所掌握的研究数据在数量和质量方面存在限制,因此,需要未来开展更多高质量的RCT研究进一步验证上述结论。

奥美拉唑联合血凝酶治疗消化道出血效果及对凝血功能的影响分析

目的 浅析奥美拉唑联合血凝酶治疗消化道出血效果及对凝血功能的影响。方法 非随机选取2022年11月—2023年11月湖南省人民医院收治的80例上消化道出血患者作为研究对象,根据治疗方式不同分为对照组和观察组,每组40例。对照组给予奥美拉唑;观察组在奥美拉唑基础上联合矛头蝮蛇血凝酶。比较两组止血时间、再出血率、血清学指标、凝血功能指标和治疗有效率的差异。结果 观察组止血时间短于对照组,再出血率低于对照组,差异有统计学意义(P均<0.05);治疗前,两组血清学指标比较,差异无统计学意义(P均>0.05),治疗后,两组血清学指标均较之前改善,且观察组优于对照组,差异有统计学意义(P均<0.05);观察组治疗有效率为100.00%(40/40),高于对照组的82.50%(33/40),差异有统计学意义(χ^(2)=5.636,P<0.05)。结论 奥美拉唑联合矛头蝮蛇血凝酶治疗消化道出血,有助于改善机体生长因子水平,降低炎症反应,修复凝血功能,整体疗效与预后理想。

钛夹止血联合尖吻蝮蛇血凝酶在急性非静脉曲张性上消化道出血中的应用

目的探讨肽夹止血联合尖吻蝮蛇血凝酶(HCA)在急性非静脉曲张性上消化道出血(ANVUGIB)中的应用效果。方法选取2020年1月—2022年7月我院收治的108例非静脉曲张性上消化道出血患者为研究对象,按照入院顺序编号,将其以单双号的方式分为对照组(n=54,单号)和观察组(n=54,双号)。对照组采用内镜下金属钛夹止血,观察组采用内镜下金属钛夹联合HCA止血。比较两组患者止血效果、临床症状改善时间、并发症情况、治疗前后凝血功能变化[纤维蛋白原(FBG)、凝血活酶时间(APTT)、凝血酶原时间(PT)、血小板(PLT)水平]、氧化应激反应及术后3个月内再次出血率。结果观察组治疗后的总出血量低于对照组,止血总有效率(98.15%)高于对照组(87.04%)(均P<0.05);观察组粪便潜血转阴时间、呕血消失时间、恢复肠鸣音时间、止血时间、住院时间均显著短于对照组(均P<0.05);两组术后并发症发生率无明显差异(P>0.05);治疗后,两组FIB、PLT水平显著升高,且观察组高于对照组,两组APTT、PT、氧化应激水平均显著降低,且观察组低于对照组(均P<0.05);观察组术后3个月内再出血率(1.85%)显著低于对照组(12.96%)(P<0.05)。结论应用内镜下钛夹止血结合HCA进行止血,可提高止血效果,缩短临床症状缓解时间,优化氧化应激状态,改善凝血功能,降低并发症,降低术后出血率,具有临床推荐使用的意义。

纳吸棉鼻腔填塞对内镜下泪囊鼻腔吻合术的影响

目的:探讨在吻合口周围放置可吸收材料纳吸棉对内镜下泪囊鼻腔吻合术(En-DCR)术后再出血、不适感及成功率的影响。方法:前瞻性随机对照研究。收集2020-11/2021-10在湖北医药学院附属人民医院眼科就诊且诊断为慢性泪囊炎并进行En-DCR手术的成年患者101例101眼,随机分成两组:填塞组49眼手术结束时用修剪后的可吸收材料纳吸棉填塞在吻合口周边鼻腔,非填塞组52眼术后则不做处理。术后随访9 mo,比较两组患者术后再出血情况、鼻腔舒适度及术后成功率(包括解剖成功率和功能成功率)。结果:所有患者均顺利完成常规En-DCR手术。填塞组4眼,非填塞组3眼术后未完成随访,最终共纳入患者94例94眼,其中填塞组45例45眼,非填塞组49例49眼。术后解剖成功率填塞组为93%(42/45)、非填塞组为88%(43/49)(P>0.05);术后功能成功率:填塞组为89%(40/45)、非填塞组为86%(42/49)(P>0.05)。填塞组1眼(2%),非填塞组9眼(18%)术后发生再出血情况(P<0.05)。填塞组2例(4%),非填塞组9例(18%)术后鼻腔不适(P<0.05)。所有患者均未出现眼眶脂肪脱垂、脑脊液漏、鼻窦炎、视力损害、视物重影等其他并发症。结论:En-DCR手术结束时鼻腔填塞可吸收材料纳吸棉可减少术后再出血及患者术后不适感,对术后成功率无明显影响。

注射用矛头蝮蛇血凝酶联合奥美拉唑治疗老年急性上消化道出血患者的效果

目的:观察注射用矛头蝮蛇血凝酶联合奥美拉唑治疗老年急性上消化道出血患者的效果。方法:选取2022年1月至2024年2月该院收治的60例老年急性上消化道出血患者进行前瞻性研究,按照随机数字表法分为观察组与对照组各30例。对照组采用注射用奥美拉唑钠治疗,观察组在对照组基础上联合注射用矛头蝮蛇血凝酶治疗,比较两组出血停止时间、腹痛消失时间、住院时间、凝血功能指标(凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原)水平、应激指标(血清皮质醇、去甲肾上腺素)水平和不良反应发生率。结果:观察组出血停止时间、腹痛消失时间和住院时间均短于对照组,差异有统计学意义(P<0.05);治疗后,两组凝血酶原时间和活化部分凝血活酶时间短于治疗前,且观察组短于对照组,两组纤维蛋白原水平高于治疗前,且观察组高于对照组,差异均有统计学意义(P<0.05);治疗后,两组血清皮质醇、去甲肾上腺素等应激指标水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:注射用矛头蝮蛇血凝酶联合奥美拉唑治疗老年急性上消化道出血患者可缩短出血停止时间、腹痛消失时间和住院时间,改善凝血功能指标水平,以及降低应激指标水平,效果优于单纯奥美拉唑治疗。

注射用白眉蛇毒血凝酶对外科手术切口止血疗效和安全性的Meta分析

目的 探讨注射用白眉蛇毒血凝酶对外科手术切口止血的有效性和安全性。方法 计算机检索万方、VIP、CNKI,收集白眉蛇毒血凝酶在外科手术切口中止血的随机对照试验(RCT),检索时间为建库至2023年12月1日。采用RevMan 5.4软件进行Meta分析。结果 共纳入13项RCT,共1 027例患者。Meta分析结果显示,白眉蛇毒血凝酶组的平均止血时间、单位面积出血量、术中出血量和术后第1天的凝血酶时间(TT)均小于对照组(P <0.05);活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)及纤维蛋白原(FIB)含量方面,两组差异无统计学意义(P>0.05)。亚组分析显示,不同类型的手术切口中,白眉蛇毒血凝酶组的止血时间、单位面积的出血量及术中出血量均减少(P <0.05)。神经外科手术切口术后第1天白眉蛇毒血凝酶组PT大于对照组(P<0.05),两组TT、APTT、FIB差异无统计学意义(P> 0.05);鼻内镜手术、普通外科手术切口术后第1天两组TT、APTT、PT、FIB差异均无统计学意义(P>0.05);妇科手术切口术后第1天白眉蛇毒血凝酶组TT、PT低于对照组(P<0.05),两组APTT、FIB差异无统计学意义(P>0.05)。共有6项研究对白眉蛇毒血凝酶使用后的不良反应进行报道,其中4项研究并未观察到任何不良反应。结论 与对照组相比,白眉蛇毒血凝酶对外科手术切口的止血疗效更佳,且对患者凝血功能影响较小,未增加不良反应事件的发生,安全性较好。

聚桂醇和蛇毒血凝酶注射配合内镜下套扎治疗乙型肝炎肝硬化并发EVB患者疗效研究

目的探讨聚桂醇和蛇毒血凝酶注射配合内镜下套扎(EVL)治疗乙型肝炎肝硬化(LC)并发食管胃底静脉曲张破裂出血(EVB)患者的临床效果。方法2021年1月~2023年1月我院收治的98例乙型肝炎肝硬化并发EVB患者被分成对照组49例和观察组49例,分别采取EVL治疗或聚桂醇和蛇毒血凝酶注射联合EVL治疗,随访6个月。使用超声检测门静脉压(PVP)、门静脉内径(PVD)、门静脉血流速度(PVV)和门静脉血流量(PVF),采用ELISA法检测血清胃泌素(GAS)、胰高血糖素(GLC)和胃动素(MTL)水平。结果急性期观察组和对照组病死率分别为16.3%和18.4%(P>0.05),观察组止血显效率为65.3%,显著高于对照组的53.1%(P<0.05);治疗后,观察组PVP、PVV和PVF分别为(21.4±2.7)mmHg、(17.9±2.4)cm/s和(552.1±138.4)mL/min,均显著低于对照组【(24.5±2.8)mmHg、(21.9±2.2)cm/s和(735.2±159.7)mL/min,P<0.05】;观察组血清GLC和MTL水平分别为(45.6±7.6)ng/L和(214.6±19.7)ng/L,均显著低于对照组【分别为(56.3±8.4)ng/L和(248.2±22.3)ng/L,P<0.05】;观察组胸骨后疼痛发生率为24.4%,显著高于对照组的2.5%,而再出血发生率为4.9%,显著低于对照组的25.0%(P<0.05)。结论采用聚桂醇和蛇毒血凝酶注射联合EVL治疗LC并发EVB患者可显著提高止血效果,降低再出血发生率,值得进一步研究。

酚磺乙胺注射液与白眉蛇毒血凝酶、维生素K_(1)联合在新生儿便血治疗中的价值

目的:分析酚磺乙胺注射液与白眉蛇毒血凝酶、维生素K_(1)联合在新生儿便血治疗中的价值。方法:选取2019年10月—2022年12月江南大学附属儿童医院收治的90例新生儿便血患儿作为研究对象,按随机数表法分成两组,对照组实施酚磺乙胺注射液治疗,观察组实施酚磺乙胺注射液与白眉蛇毒血凝酶及维生素K_(1)治疗。比较两组临床疗效、不良反应发生率、炎症因子水平。结果:观察组总有效率高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率对比,差异无统计学意义(P>0.05)。观察组白细胞介素-6(interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)低于对照组,白细胞介素-10(interleukin-10,IL-10)高于对照组,差异有统计学意义(P<0.05)。结论:酚磺乙胺注射液与白眉蛇毒血凝酶、维生素K_(1)联合在新生儿便血治疗中可行性较高,可以改善炎症状态,提升治疗效果和安全性。

白眉蛇毒血凝酶辅助治疗非静脉曲张性上消化道出血的效果

目的:探讨白眉蛇毒血凝酶辅助治疗非静脉曲张性上消化道出血(non-variceal upper gastrointestinal bleeding,NVUGIB)的效果。方法:选取2022年2月—2023年2月松滋市中医医院收治的120例NVUGIB患者。随机将其分为对照组和观察组,各60例。两组均给予常规止血对症治疗,观察组在此基础上给予白眉蛇毒血凝酶辅助治疗。比较两组相关指标,治疗前后炎症因子、血液流变学指标,治疗效果及不良反应。结果:观察组输血量少于对照组,止血时间短于对照组,差异有统计学意义(P<0.05)。治疗后,两组C反应蛋白(C-reactive protein,CRP)及血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平均降低,观察组CRP、TNF-α水平均低于对照组,差异有统计学意义(P<0.05)。治疗后,两组红细胞沉降率(erythrocyte sedimentation rate,ESR)降低,红细胞比容(packed cell volume,PCV)、全血高切黏度、全血低切黏度均增高,观察组ESR低于对照组,PCV、全血高切黏度、全血低切黏度均高于对照组,差异有统计学意义(P<0.05)。观察组总有效率高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:NVUGIB患者使用白眉蛇毒血凝酶辅助治疗效果良好,可有效减轻患者炎症反应,改善血液流变学,达到快速止血效果,减少输血量,不会增加患者不良反应。

蛇毒血凝酶联合维生素K 1治疗新生儿消化道出血的临床效果

目的观察蛇毒血凝酶联合维生素K 1治疗新生儿消化道出血的临床效果。方法回顾性分析2022年3月—2024年3月福建医科大学附属三明第一医院收治的75例新生儿消化道出血患儿临床诊疗资料,以治疗方案不同分为观察组(38例)和对照组(37例)。在常规治疗基础上,对照组单纯予维生素K 1注射液治疗,观察组在对照组基础上加用蛇毒血凝酶注射液治疗,2组均治疗3 d。比较2组治疗效果,呕血、血便、腹胀等症状改善及粪便隐血试验转阴时间,治疗前1 d、治疗后3 d凝血功能指标[纤溶酶原激活物抑制剂-1(PAI-1)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、D-二聚体(D-D)、组织型纤溶酶原激活物(t-PA)]水平及不良反应。结果观察组患者治疗总有效率为97.37%,高于对照组的83.78%(χ2=4.088,P=0.043);观察组呕血、血便、腹胀等症状改善及粪便隐血试验转阴时间均短于对照组(P<0.01)。治疗后3 d,2组TT、APTT、t-PA较治疗前缩短或降低,其余指标升高(PAI-1对照组内比较无差异),且观察组降低或升高程度均大于对照组(P<0.05或P<0.01)。观察组不良反应总发生率为5.26%,低于对照组的21.62%(χ2=4.341,P=0.037)。结论蛇毒血凝酶联合维生素K 1治疗新生儿消化道出血的临床效果肯定,可有效改善症状与凝血功能指标,且用药安全性高。