摘要
目的探究重组活化因子Ⅶ(rFⅦa)治疗冠状动脉旁路移植术(CABG)术后凝血功能障碍所致出血的有效性与安全性。方法回顾收集2021年1月至2021年12月首都医科大学附属北京安贞医院接受CABG术后发生凝血功能障碍的患者。根据患者是否使用rFⅦa治疗,将患者分为两组:rFⅦa组与对照组。收集患者围术期相关信息,进行统计学分析,通过比较手术后引流量评价有效性,比较术后血栓相关并发症与结局评价安全性。结果排除外科因素出血的患者后,本研究共计纳入87例患者,rFⅦa组56例,对照组31例,其中单纯CABG患者52例,其余术式患者35例,应用体外循环手术共计55例。与对照组相比,rFⅦa组患者凝血酶原时间明显缩短[11.90(10.50~14.20)s vs.14.35(13.50~17.65)s,P<0.001],D-二聚体水平更高[492.00(191.00~1220.00)μg/L vs.276.50(158.00~463.50)μg/L,P=0.026],12 h引流量更少[1170(800,1400)ml vs.1000(850,1500)ml,P=0.032]。安全性的相关指标:肺动脉压收缩压[29.00(23.00~37.00)mmHg vs.29.00(23.00~32.00)mmHg,P=0.617]、围术期心肌梗死[8例(14.29%)vs.5例(16.13%),P=0.817]、深静脉血栓形成[4例(10.26%)vs.2例(12.50%),P>0.999]、神经系统损伤[6例(10.71%)vs.8例(26.67%),P=0.109]、全因死亡[8例(14.29)vs.8例(25.81),P=0.184],两组间均无统计学差异。结论CABG术后患者因凝血功能障碍出血应用rFⅦa进行止血治疗,有较好的有效性与安全性,但仍需在应用rFⅦa治疗期间严密监测血栓相关并发症的体征与相关化验检查指标。
Objective To investigate the effectiveness and safety of recombinant activated factor(rFⅦa)in treating coagulopathy-related bleeding after coronary artery bypass grafting(CABG).Methods We retrospectively collected data of patients who experienced coagulopathy after undergoing CABG at Beijing Anzhen Hospital,Capital Medical University,from January 2021 to December 2021.Patients were divided into two groups based on whether they received treatment with recombinant activated factorⅦ(rFⅦa):the rFⅦa group and the control group.We collected perioperative information of patients,conducted statistical analysis,evaluated the effectiveness by comparing postoperative drainage,and assessed the safety by comparing thrombotic complications and outcomes after surgery.Result A total of 87 patients were included in this study,with 56 in the rFⅦa group and 31 in the control group.Among them,there were 52 patients undergoing isolated coronary artery bypass grafting and 35 patients undergoing other procedures,with a total of 55 undergoing cardiopulmonary bypass surgery.Compared with the control group,patients in the rFⅦa group had significantly shortened PT[11.90(10.50-14.20)seconds vs 14.35(13.50-17.65)seconds,P<0.001],higher levels of D-dimer[492.00(191.00-1220.00)ng/ml vs 276.50(158.00-463.50)ng/ml,P=0.026],and less drainage at 12 hours[1170(800,1400)ml vs 1000(850,1500)ml,P=0.032].Relevant indicators of safety:SPAP[29.00(23.00-37.00)mmHg vs 29.00(23.00-32.00),P=0.617],perioperative myocardial infarction[8(14.29%)cases vs 5(16.13%)cases,P=0.817],deep vein thrombosis[4(10.26%)cases vs 2(12.50%)cases,P>0.999],neurological injury[6(10.71%)cases vs 8(26.67%)cases,P=0.109],all-cause mortality[8(14.29%)cases vs 8(25.81%)cases,P=0.184]showed no statistical difference between the two groups.Conclusion Patients with coagulation dysfunction bleeding after coronary artery bypass grafting surgery have good efficacy and safety in hemostatic treatment with rFⅦa.And,it is crucial to closely monitor for symptoms and signs of thromb
作者
于岩
刘楠
Yu Yan;Liu Nan(Center of Cardiac Intensive Care Unit Beijing Anzhen Hospital,Capital Medical University,Beijing 100011,China)
出处
《中国体外循环杂志》
2024年第2期87-92,共6页
Chinese Journal of Extracorporeal Circulation
关键词
心脏外科
冠状动脉旁路移植术
出血
重组活化因子Ⅶ
Cardiac surgery
Coronary artery bypass grafting
Bleeding
Recombinant activated factorⅦ
