《中国康复理论与实践》

《中国康复理论与实践》 ›› 2005, Vol. 11 ›› Issue (03): 218-221.

• 临床研究 • 上一篇    下一篇

蛇毒血凝酶对神经外科手术中凝血功能的影响

何悦; 王保国; 姜金玉   

  1. 首都医科大学附属北京天坛医院麻醉科 北京市 100050
  • 收稿日期:2004-10-19 出版日期:2005-03-25 发布日期:2005-03-25

Effects of hemocoagulase on coagulation function during neurosurgical operation

HE Yue, WANG Bao-guo, JIANG Jin-yu   

  1. Department of Anesthesiology, Beijing Tiantan Hospital, Capital University of Medical Sciences, Beijing 100050, China
  • Received:2004-10-19 Published:2005-03-25 Online:2005-03-25

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被引次数

18

摘要： 目的对比观察不同剂量的巴曲亭和立止血对神经外科手术中6%贺斯扩容性血液稀释期间、术中和术后凝血及血小板功能变化的影响。方法本研究采用前瞻、随机、双盲、对照的方法,将60例行开颅手术的患者分为对照组(Ⅰ组,15例)、巴曲亭2kU组(Ⅱ组,15例)、巴曲亭4kU组(Ⅲ组,15例)和立止血2kU组(Ⅳ组,15例)。麻醉诱导插管后,静脉输注6%HAESSteril 1000ml扩容,并在开始扩容时按组经静脉注射上述止血药。分别在进入手术室后、麻醉诱导后、给药后20min(扩容500ml)、给药后40min(扩容1000ml)、给药后120min、术毕和术后24h取血检测血常规及凝血功能。结果4组患者在扩容后红细胞(RBC)、血红蛋白(Hb)、红细胞压积(HCT)、血小板(PLT)、纤维蛋白原(FIB)均有不同程度的下降(P<005),术后有所恢复,在麻醉后、术后1d各参数与入室值比较无显著性差异,且不同时间点各参数的变化4组间比较无显著性差异。血浆凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血激酶时间(APTT)术中延长,其变化幅度Ⅰ组最大,术后基本恢复正常。凝血速率(CR)下降,除给药后120minⅠ组较Ⅲ组下降明显(P<005)外,其余时点各组间比较均无显著差异。结论神经外科手术中血液中度稀释后凝血功能有所下降,但均在正常范围内。立止血和巴曲亭可以部分缓解血液稀释

关键词: 蛇毒血凝酶, 止血剂, 颅脑手术, 血液稀释, 凝血

Abstract: ObjectiveTo evaluate the effects of two kinds of hemocoagulases, Reptilase and Baquting, on coagulation function during neurosurgical operation.Methods60 patients scheduled for craniotomy were randomly allocated into 4 groups to receive either normal saline as control (Group Ⅰ, n=15), Baquting 2 kU (Group Ⅱ, n=15), Baquting 4 kU (Group Ⅲ, n=15) or Reptilase 2 kU (Group Ⅳ, n=15) after propofol and isoflurane general anesthesia and before hypervolumic hemodilution with 6% HAES-steril 1000 ml. The blood samples were drown for testing routine blood parameters (Hb, HCT, PLT, RBC, etc.), coagulation parameters (PT, TT, APTT, INR, FIB), and sonoclotactivated clotting time (SonACT), rate of clot formation (CR) and platelet function (PF) using Sonoclot coagulation & platelet function analyzer before anesthesia, after anesthesia, at 20 min (HAES 500 ml infused), 40 min (HAES 1000 ml infused) and 120 min after the test drug was given, at the end of operation, and 24 h after operation.ResultsThere were an obvious prolongation or decrement in almost all parameters in all patients and restored to normal in the first day after operation. But the trends showed less changes in PT, TT, APTT, FIB, PF, CR in every Baquting and Reptilase groups compared with Group Ⅰ.ConclusionMedium hemodilution, coagulation and platelet dysfunctions happened during neurosurgical operation. Hemocoagulase can only partly but not significantly reverse the changes of hemostatic abilities in every group.

Key words: Hemocoagulase, hemostatics, neurosurgery, hemodilution, coagulation