63例心臟大血管手術使用小劑量重組活化凝血因子Ⅶ的療效分析

目的：分析心臟大血管手術中及手術後預防性和治療性使用小劑量（35～70μg/kg）重組活化凝血因子Ⅶ（rFⅦa）的療效。方法：收集2013年1月～2020年12月本院行心臟大血管手術（主動脈夾層，心臟瓣膜、冠脈搭橋、心臟腫瘤等）術中和術後使用rFⅦa的患者臨床資料，所有患者均採用體外循環下手術，並給予小劑量rFⅦa，監測應用rFⅦa前後的治療效果及不良反應。結果：63例使用rFⅦa能早期有效減少出血（P<0.05）。21例主動脈夾層手術術中預防性使用小劑量rFⅦa，術後大多數有效減少引流量（P<0.05）。有活動性血管出血的病例，rFⅦa的效果不一定理想，有8例需二次手術止血，其中7例發現有外科活動性出血。術後死亡2例，併發血栓4例。結論：對於體外循環術後嚴重滲血患者，小劑量rFⅦa具有良好的止血效果；對於主動脈夾層大血管手術病例，術中止血困難可預防性使用rFⅦa，也能減少術後引流量和出血風險，但須小心監測血栓性併發症的發生。

關鍵字

心臟大血管手術；重組活化凝血因子Ⅶ ；出血；併發症

並列摘要

Objective: To evaluate the therapeutic effects of low-dose recombinant activated factor VII (rFVIIa) (35~70μg/kg) for therapeutic or prophylactic use after cardiac and aortic surgery. Methods: From January 2013 to December 2020, all patients who underwent cardiac and aortic surgery under cardiopulmonary bypass (CPB) were therapeutic or prophylactic administrated with low dose rFVIIa. The efficacy and side-effect were evaluated after the use of rFVIIa. Results: Early use of low dose rFVIIa in 63 patients can effectively control massive bleeding (P<0.05). Compare the chest drain loss after prophylactic use for 21 cases of the aortic dissection case during the surgery; a significant reduction was also observed in the majority cases (P<0.05). Careful consideration should be taken of surgical bleeding that the effect of rFVIIa is not enough, and there was a total of 8 reoperations due to uncontrolled bleeding, 7 cases confirmed surgical bleeding site. 2 patients died, and 4 cases had thromboembolic complications. Conclusion: Low-dose rFVIIa after CPB can effectively control massive bleeding. For difficult hemostasis after the aortic dissection surgery, prophylactic use of low dose rFVIIa during operation can decrease the chest drain loss and bleeding risk; monitoring the occurrence of thromboembolic complication should be monitored aware.

並列關鍵字

Cardiac and aortic surgery ； Recombinant active factor VII ； Bleeding ； Complication

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