浓缩纤维蛋白原在高危心脏手术中的预防性应用

浓缩纤维蛋白原在高危心脏手术中的预防性应用

贵州医科大学  麻醉与心脏电生理课题组

  01   背景

围手术期失血是导致心脏手术并发症和死亡率的主要原因。血浆纤维蛋白原在止血中起重要作用，其在出血时迅速耗尽。本研究的目的是确定在血浆纤维蛋白原含量较低的高危心脏手术患者中，预防性给予浓缩纤维蛋白原是否降低了总体输血需求。

  02   方法

这项研究是以前瞻性、随机、双盲设计进行的。这项研究纳入62名接受择期高危心脏手术的患者。在进行肝素逆转体外循环结束后，患者接受浓缩纤维蛋白原治疗或安慰剂治疗。主要结局指标是干预后24小时的总体血液制品使用量。

  03   结果

纤维蛋白原组的血液制品总量低于安慰剂组，但差异没有统计学或临床意义(n=27；n=29和19vs37个单位，P=0.908)。两组患者的总体输血率均明显低于机构平均水平(纤维蛋白原组26%，安慰剂组28%)。纤维蛋白原组的纤维蛋白原水平显著高于对照组(2.38vs1.83g/L(手术结束时)，P<0.001；3.33vs2.68g/L(干预后12h)，P=0.003)，并改善了粘弹性凝血参数(FIBTEM MCF，27vs23 mm，P=0.022)。

0 4 结论

这项随机对照试验表明，在本队列研究中出乎意料的低输血率的情况下，使用浓缩纤维蛋白原进行即时治疗和预防性治疗不会减少血液制品的输注，但可能会改善高危心脏手术中的凝血参数。

  0 5 原始文献来源

Kwapisz MM, Kent B, DiQuinzio C, et al. The prophylactic use of fibrinogen concentrate in high-risk cardiac surgery. Acta Anaesthesiol Scand. 2020 May;64(5):602-612.

英文原文    

The effects of topical chlorhexidine-benzydamine  spray on laryngeal mask airway application

ABSTRACT

BACKGROUND: Laryngeal mask airway (LMA) use is very common during anesthesia practice. Sore throat, earache, hoarseness and swallowing difficulties may occur on LMA insertion. The primary aim of this study was to describe the effects of topical application of a spray formula of chlorhexidine gluconate and benzydamine hydrochloride (Kloroben® oral spray, 30 mL) on postoperative sore throat due to LMA use. The secondary aims were to evaluate earache, swallowing difficulty, nausea and vomiting and the hemodynamic responses due to LMA insertion and the incidence of coughing, tooth clenching, desaturation and laryngeal spasms during LMA removal.

METHODS: After obtaining Institutional Ethics Committee approval and written informed consent (Ref no 29/15), a total of 100 adult patients were included. In Group C, four puffs of a spray formula of chlorhexidine gluconate and benzydamine hydrochloride were applied to the nasopharyngeal area 15 min before surgery. In Group S, 0.9% saline was applied, using the same protocol.

RESULTS: When both groups were compared, more patients in Group S had cough, sore throat and swallowing difficulties one hour after surgery (P<0.05), but there was no statistically significant difference at 6, 12, and 24 h between the two groups (P>0.05). The incidence of nausea, vomiting, and earaches was similar in both groups at all measurement times (P>0.05).

CONCLUSIONS: Preemptive topical benzydamine hydrochloride and chlorhexidine gluconate in a spray formula may decrease the incidence of sore throat, cough and swallowing difficulties associated with LMA use.

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