【摘要】 目的研究在泌尿外科腹腔镜手术中,患者创面局部使用注射用白眉蛇毒血凝酶的止血效果。方法本研究为前瞻性、对照、多中心临床研究。选取2019年9月至2020年6月就诊于国内13家三等甲级医院接受泌尿外科腹腔镜手术患者1000例,将患者随机分为2组;患者在进行泌尿外科腹腔镜手术时,对手术创面给予常规的止血方法后,在手术结束前,将其中一组设置为对照组,创面喷洒10ml生理盐水;另一组设置为白眉蛇毒血凝酶组(以下简称血凝酶组),患者手术创面局部喷洒浓度为0.8KU/ml的注射用白眉蛇毒血凝酶溶液10ml。术后二组患者均未应用止血药物。记录两组患者术后引流管出血量及两组患者术前和术后凝血相关指标,并进行统计学分析。结果比较手术后引流管出血量,血凝酶组显著低于对照组,差异具有统计学意义(P<0.05);每种手术术后24h与术前相比,凝血酶时间、血浆凝血酶原时间、部分活化凝血活酶时间、血浆纤维蛋白原四项指标的差值,差异没有统计学差别(P>0.05),组间相比变化差异没有统计学差别(P>0.05);术后24h与术前相比,D-二聚体含量明显升高,差异有统计学差别(P<0.05),组间相比变化差异没有统计学差别(P>0.05)。结论泌尿外科腹腔镜手术创面局部喷洒注射用白眉蛇毒血凝酶安全有效,能够有效减少术后的渗血和术后引流量,且止血效果只在手术创面局部起效,对患者全身的凝血功能没有明显影响。更多还原

【Abstract】 Objective To explore and analyze the hemostasis effect of local hemocoagulase injection during the laparoscopic urology surgery. Methods From Sep 2019 to June 2020,1000 patients underwent laparoscopic urology surgery in 13 hospitals were randomly divided into 2 groups. Normal saline were used in the surgical area in control group,while hemocoagulase was locally applied in the hemocoagulase-application group. Then the postoperative drainage and blood loss in these 2 groups were recorded and analyzed. Routine coagulation tests were performed and compared in these groups preoperatively and postoperatively. Results Between these two groups of patients underwent laparoscopic urology surgery respectively,significant differences in blood loss and drainage amount were found. The blood loss and drainage amount were less in the hemocoagulase-application group than those of the control group(P < 0. 05). There was no significant change between the data of thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),plasma fibrinogen(Fib)and D-Dimer between these two groups postoperatively(P > 0. 05). The postoperative D-Dimer was higher than that before surgery,however,there is no significant difference between two groups. Conclusions Local hemocoagulase injection during the laparoscopic upper urinary tract surgery is safe and effective,and it had no significant effect on the patients coagulation function.更多还原