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重組人凝血因子VIIa應用於體外循環術後嚴重滲血患者的臨床分析
Clinical study on the role of recombinant activated factor VIIa in the management of massive hemorrhage following cardiopulmonry bypass
摘要
目的：總結重組人凝血因子VIIa（rFVIIa）治療體外循環術後嚴重滲血的治療經驗。方法：就2009年11月～2012年11月共15例，體外循環手術後嚴重滲血患者應用rFVIIa治療後進行臨床分析。其中男性13例，女性2例；年齡28歲～83歲，平均62.3歲。手術包括室間隔缺損修補術1例，冠狀動脈搭橋術5例，瓣膜置換手術4例，主動脈手術5例；監測應用rFVIIa前後的治療效果及不良反應。結果：應用rFVIIa後，心包及縱膈引流量明顯減少；異體輸血量，凝血酶原時間（PT），國際標準化比值（INR）明顯縮短；血小板（Plt），活化部份凝血活酶時間（APTT）則在用藥前後差異無統計學差異。術後死亡3例，（2例死亡原因為多器官功能衰竭，1例為猝死）；其中1例因多器官功能衰竭死亡患者早期併發雙側頸靜脈血栓形成，1例併發單側頸靜脈血栓形成，猝死患者未能排除心肌梗死或肺梗塞的可能。結論：rFVIIa對於體外循環術後嚴重滲血患者，rFVIIa具有良好的止血效果，但有一定的血栓性併發症發生率。應用前需小心對rFVIIa應用作風險利益評估，建議只作為搶救性治療，用了傳統止血措施應用後仍嚴重滲血的患者；而且應由小劑量開始用藥，應用後需小心監測血栓性併發症的發生。
並列摘要
Objective: To evaluate the therapeutic effects of administration of recombinant activated factor VIIa (rFVIIa) for massive hemorrhage after cardiac surgery under cardiopulmonary bypass(CPB). Methods: From November 2009 to November 2012, 15 patients underwent cardiac surgery under CPB were administrated with rFVIIa, male for 13 cases and female for 2 cases, aged from 28 to 83 years old with a mean of 62.3. The surgical procedures included repair of ventricular septal detect for 1 case, coronary artery bypass grafting for 5 cases, valve replacement for 4 cases, aortic procedure for 5 cases. The efficacy and side-effect were evaluated after the use of rFVIIa. Results: After rFVIIa therapy, a significant reduction was observed in chest drain loss, PT and INR, but there was an insignificant reduction in Plt and APTT. 2 patient died postoperatively due to multiple organ system failure, One patient died of sudden death. One dead case (because of multiple organ system failure) was complicated with thrombosis of bilateral carotid veins, another case complicated with thrombosis of unilateral carotid vein. The sudden death case could not rule out the possibilities of myocardial infraction or pulmonary embolism. Conclusion: rFVIIa can effectively improve the coagulation function in patients receiving cardiac operation under CPB and reduce the need for blood transfusion. However, considering the risk of thromboembolic adverse effects, it should be emphasis that careful risk-benefit analysis should be made before using rFVIIa. We recommend it should be only use as rescue therapy for blood loss that refractory to standard hemostatic therapies. Moreover, it should be use in small dose at the beginning, and careful monitoring the occurrence of thromboembolic complication should be aware.