2023 年第 2 期 第 18 卷

重组人活化凝血因子Ⅶ在急性A型主动脉夹层手术中的应用研究

Application of recombinant human activated factor Ⅶ in acute type A aortic dissection surgery

作者：李媛明李冠军王大帅吴龙董念国邱雪峰

英文作者：Li Yuanming Li Guanjun Wang Dashuai Wu Long Dong Nianguo Qiu Xuefeng

单位：华中科技大学同济医学院附属协和医院心脏大血管外科，武汉430022

英文单位：Department of Cardiovascular Surgery Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China

关键词：急性A型主动脉夹层；重组人活化凝血因子Ⅶ；出血

英文关键词：AcutetypeAaorticdissection;RecombinanthumanactivatedfactorⅦ;Hemorrhage

• 摘要：

• 目的 评价重组人活化凝血因子Ⅶ（rFⅦa）对急性A型主动脉夹层（ATAAD）手术围手术期顽固性出血的治疗效果及对术后肺部感染并发症的影响。方法 收集2016年9月1日至2019年5月30日于华中科技大学同济医学院附属协和医院实施主动脉夹层手术的100例ATAAD患者的临床资料行回顾性分析。根据治疗方式的不同将患者分为rFⅦa组(65例)和对照组（35例）。对照组仅接受常规治疗，rFⅦa组接受常规治疗及rFⅦa术中静脉输注治疗。对比分析2组患者的一般资料、临床效果指标及肺部感染并发症指标。结果 rFⅦa组体外循环时长长于对照组，差异有统计学意义（P<0.05）。rFⅦa组术后24 h纵隔胸管引流量少于对照组，输注新鲜冰冻血浆量大于对照组，差异均有统计学意义［（370±161）ml比（489±267）ml、（650±355）ml比（465±347）ml］（均P<0.05）。2组机械通气时长、重症监护病房停留时长、住院时长、输注浓缩红细胞量、输注血小板量差异均无统计学意义（均P>0.05）。rFⅦa组和对照组痰培养革兰阴性杆菌阳性率差异无统计学意义［43.1%（28/65）比37.1%（13/35）］（P>0.05）。结论 对于ATAAD患者围手术期顽固性出血，应用rFⅦa能够显著减少术后24 h引流量，但会增加体外循环时长和术后血液制品的输注，肺部感染并发症发生率与常规治疗相似。

• Objective  To evaluate the effect of recombinant human activated factor Ⅶ(rFⅦa) on refractory hemorrhage during the perioperative period and postoperative complications of pulmonary infection in patients with acute type A aortic dissection(ATAAD). Methods  From September 1, 2016 to May 30, 2019, the clinical data of 100 ATAAD patients who underwent aortic dissection surgery in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected for retrospective analysis. The patients were divided into rFⅦa group(65 cases) and control group(35 cases) according to different treatment Methods  . The control group only received routine treatment, while the rFⅦa group received routine treatment and rFⅦa intravenously during operation. The general data, clinical effect indicators and complications indicators of pulmonary infection between the two groups were compared and analyzed. Results  The duration of cardiopulmonary bypass in rFⅦa group was longer than that in control group(P<0.05). Drainage volume of mediastinal thoracic duct in 24 h after operation in rFⅦa group was less than that in control group, and the volume of fresh frozen plasma transfused was more than that in control group［(370±161) ml vs (489±267) ml, (650±355) ml vs (465±347) ml］(both P<0.05). There were no significant differences between the two groups in the duration of mechanical ventilation, the length of stay in the intensive care unit, the length of hospitalization, and the amount of packed red blood cell and platelet transfusion (all P>0.05). There was no significant difference in the positive rate of Gram-negative bacillus in sputum culture between rFⅦa group and control group［43.1%(28/65) vs 37.1%(13/35)］(P>0.05). Conclusions  rFⅦa significantly reduces the postoperative drainage volume in 24 h after surgery for the refractory hemorrhage in ATAAD patients during the perioperative period. Otherwise, it increases the duration of cardiopulmonary bypass and the transfusion of blood products, and the incidence rate of complications of pulmonary infection is similar to the routine treatment.