胡正祥 柯学庭 尹东旭 陈茵茵

【摘要】 目的：探讨去氨加压素联合血小板在抗凝及抗血小板相关性脑出血围术期止血效果。方法：将2017年1月-2019年1月笔者所在医院收治的200例抗凝及抗血小板相关性脑出血患者分为观察组和对照组，各100例。对照组仅采用血小板输注治疗，观察组在对照组基础上加用去氨加压素。通过观察两组PT、APTT、INR、术中出血量、术后引流量及再出血量等情况，评价去氨加压素联合血小板在抗凝及抗血小板相关性脑出血围术期止血效果。结果：两组治疗后PT、APTT、INR均低于治疗前，且观察组明显低于对照组，差异均有统计学意义（P<0.05）。对照组术中出血量、术后引流量及再出血量均明显多于观察组，差异均有统计学意义（P<0.05）。结论：去氨加压素联合血小板可改善抗凝及抗血小板相关性脑出血患者凝血功能障碍，降低围术期出血风险，从而提高手术成功率，值得临床推广应用。

【关键词】 去氨加压素 血小板 抗凝 抗血小板 脑出血 围术期 止血效果

doi：10.14033/j.cnki.cfmr.2019.29.007 文献标识码 B 文章编号 1674-6805（2019）29-00-02

[Abstract] Objective： To investigate the hemostatic effect of Desmopressin combined with platelet in anticoagulation and antiplatelet-related cerebral hemorrhage during perioperative period. Method： A total of 200 patients with anticoagulation and antiplatelet-related cerebral hemorrhage admitted to our hospital from January 2017 to January 2019 were divided into the observation group and the control group， 100 cases in each group. The control group was treated only with platelet transfusion， while the observation group was treated with Desmopressin on the basis of the control group. By observing the conditions of PT， APTT， INR， intraoperative bleeding volume， postoperative drainage volume and rebleeding volume of the two groups， the hemostatic effect of Desmopressin combined with platelet in anticoagulation and antiplatelet-related cerebral hemorrhage during perioperative period was evaluated. Result： PT， APTT and INR of the two groups after treatment were lower than those before treatment， and the observation group were significantly lower than those of the control group， and the differences were statistically significant （P<0.05）. Intraoperative bleeding volume， postoperative drainage volume and rebleeding volume in the control group were significantly more than those of the observation group， and the differences were statistically significant （P<0.05）. Conclusion： Desmopressin combined with platelets can improve coagulation dysfunction in patients with anticoagulation and antiplatelet related intracerebral hemorrhage， reduce the risk of perioperative bleeding， thereby improving the success rate of surgery， and is worthy of clinical application.

[Key words] Desmopressin Platelet Anticoagulation Antiplatelet Cerebral hemorrhage Perioperative period Hemostatic effect

First-authors address： Peoples Hospital of Zhongkai High-tech Zone， Huizhou City， Huizhou 516229， China

近年來，随着社会老龄化的到来，心脑血管等疾病的发生率呈上升趋势[1]。为了降低心脑血管不良事件的发生，抗凝及抗血小板药物在脑梗死及心血管疾病治疗中得到广泛应用[2]。目前国内外均有研究证明，抗血小板及抗凝药物可增加脑出血风险，由药物引发的脑出血患者也呈明显增多趋势。因此，改善药物相关性脑出血患者凝血障碍，降低围术期出血风险，提高手术成功率，降低致残率和致死率是目前临床研究的重点[3-4]。目前国内外多项研究表明，去氨加压素具有良好的升高血浆凝血因子水平的作用，且无血管收缩等副作用，能缩短临床侵入性治疗或诊断性手术时的出血时间[5]。血小板是血液的重要组成部分，对机体的止血功能极为重要。……