早期应用重组活化凝血因子Ⅶ对重型颅脑外伤的临床疗效

摘要

Objective To investigate the curative effect of recombinant activated factor Ⅶ ( rFⅦa) on treating patients with severe traumatic brain injury (TBI).Methods 40 patients with TBI were randomly divided into the treatment group (n=20) and the control group (n=20).Patients in the control group accepted only conventional treatment , while the treatment group accepted an addition dose rFⅦa (40 mg/kg) on admission.The observation window was 168 hours for change of coagulation parameters and adverse events .And the other changes in intraoperative blood loss , reoperation rate ,mortality ,3 months Glasgow outcome scale ( GOS ) score were observed .Results Compared with the control group ,differences were significant with regard to PT ,APTT,FDP,DD ( all P<0.05).The intraoperative blood loss was (500 ±194.3) ml and (1030 ±427.0)ml,the 168 h concentrated red cell transfusion amount was (1.70 ±1.72)u and (3.61 ±1.73)u,the reoperation rate was 15%(3/20) and 45%(9/20),the mortality was 15%(3/20) and 45%(9/20),the 3 months GOS score was (3.20 ±1.28) and (2.35 ±1.31) in the treatment and control group respectively (all P<0.05).Conclusion Early application of rFⅦa for patients with TBI can improve blood coagulation function , reduce reoperation rate and mortality , which can improve the clinical efficacy and activity ability of daily living .%目的 探讨重型颅脑外伤患者早期应用重组活化凝血因子Ⅶ(rFⅦa)的临床疗效.方法40例重型颅脑外伤患者随机分为rFⅦa治疗组和对照组,每组各20例.对治疗组的患者入院时给予rFⅦa 40μg/kg静脉注射;治疗组和对照组其他治疗均按颅脑外伤常规治疗进行.比较两组患者入院时(0 h)、治疗后第1 d(24 h)、第3 d(72 h)、1周(168 h)的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白降解产物(FDP)、D-二聚体(D-D)等凝血功能指标的变化,以及术中出血量、迟发性血肿二次手术率、死亡率、术后3个月时的格拉斯哥预后量表(GOS)评分.结果与对照组相比,rFⅦa治疗组能明显减低PT、APTT、FDP、DD异常增高的幅度(均P<0.05).rFⅦa治疗组的术中出血量[(500±194.3)ml]、术后1周内浓缩红细胞输注量[(1.70±1.72)U]、迟发性血肿二次手术率(15%)和术后3个月内死亡率(15%)均显著低于对照组[(1030±427.0)ml,(3.61±1.73)U,45%,45%];GOS评分[(3.20±1.28)分]显著高于对照组[(2.35±1.31)分],差异均具有统计学意义(均P<0.05).结论重型颅脑外伤患者早期应用rFⅦa能改善患者的凝血功能障碍,显著减少患者的迟发性血肿发生率、二次手术率及死亡率;从而提高其临床疗效,改善预后.