摘要
目的 探讨药代动力学(PK)指导下血友病A手术患者围手术期管理。方法 对2013年01月至2023年02月广西医科大学第一附属医院收治的29例血友病A手术患者PK及临床资料进行回顾性分析。将患者按照治疗方式分为体重指导治疗组(n=19)与PK指导治疗组(n=10)。主要分析指标为目标凝血因子达标率,安全性分析,围手术期相关并发症,包括出血、血栓、二次手术、输血,次要分析指标为围手术期凝血因子Ⅷ(factorⅧ,FⅧ)消耗量。结果 PK指导治疗组围手术期目标凝血因子达标率为88%,体重指导治疗组为33%,差异有统计学意义(P<0.01)。PK指导治疗组出血事件发生率为90%,均为1级出血事件;体重指导治疗组出血事件发生率为100%,其中1级出血事件发生率为78.9%,2级出血事件发生率为10.5%,3级及4级出血事件发生率均为6.7%,两组出血事件发生率差异有统计学意义(P<0.05)。PK指导治疗组未发生输血治疗,体重指导治疗组输血治疗发生率为21.1%;两组均无合并血栓、二次手术病例,均未发生与治疗相关的死亡。PK指导治疗组的围手术期凝血因子中位消耗量为116.5 IU/kg,而体重指导治疗组为120IU/kg,差异无统计学意义(P>0.05)。结论 围手术期血友病A患者PK指导治疗组较体重指导治疗组目标凝血因子达标率明显升高,且减少了出血事件的发生率及输血治疗,值得临床推广。
Objective To investigate the perioperative management of hemophilia A patients under the guidance of pharmacokinetics(PK).Methods PK and clinical data of 29 hemophilia A patients admitted to the First Affiliated Hospital of Guangxi Medical University from January 2013 to February 2023 were retrospectively analyzed.The patients were divided into weight-guided treatment group(n=19)and PK-guided treatment group(n=10)according to treatment mode.The main analysis parameter was the target coagulation factor compliance rate.The safety analysis included perioperative complications,incidence of bleeding or thrombosis,requirement of second operation and blood transfusion,and the perioperative coagulation factorⅧ(factorⅧ,FⅧ)consumption.Results The perioperative target coagulation factor sccucess rate was 88%in the PK-guided treatment group and 33%in the weight-guided treatment group,and the difference in median target coagulation factor sccucess rate between the two groups was statistically significant(P<0.01).The incidence of bleeding events in the PK-guided treatment group was 90%,and all were grade 1 bleeding events;the incidence of bleeding events in the weight-guided treatment group was 100%,with the incidence of grade 1 bleeding events being 78.9%,the incidence of grade 2 bleeding events being 10.5%and the incidence of grade 3 and grade 4 bleeding events were both 6.7%.The difference in the incidence of bleeding events between the two groups was statistically significant(P<0.05).The incidence of bleeding events was significantly different between the two groups(P<0.05).There was no blood transfusion in PK group,and the incidence of blood transfusion was 21.1%in weight group.There were no cases of thrombosis or secondary operation in both groups,and no treatment-related death occurred.The median consumption of perioperative coagulation factor was 116.5 IU/kg in the PK-guided treatment group and 120 IU/kg in the weight-guided treatment group.There was no statistically significant difference between the two groups(P>0.05).Conclusion Compared with the weight-guided treatment group,the PK-guided treatment group for perioperative hemophilia A patients had a better effect on the target coagulation factor compliance rate,and reduced the bleeding events and blood transfusion treatment,which is worthy of clinical promotion.
作者
卜声镝
张福勇
许玉玲
程鹏
罗高斌
龙媛
Bu Shengdi;Zhang Fuyong;Xu Yuling;Cheng Peng;Luo Gaobin;Long Yuan(.Department of Hematology,Nanning First People’s Hospital,Nanning 530022,China;Department of Laboratory Medicine,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Hematology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Orthopedics and Joint Surgery,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)
出处
《血栓与止血学》
CAS
2024年第1期16-22,共7页
Chinese Journal of Thrombosis and Hemostasis
基金
广西壮族自治区卫生健康委员会自筹经费科研课题(Z20210997)。
关键词
药代动力学
血友病A
围手术期
Pharmacokinetics
Hemophilia A
Perioperative period
