von Heymann C, Spies C, Grubitzsch H, Schönfeld H, Sander M, Volk Th
Klinik für Anästhesiologie und operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany.
Hamostaseologie. 2006 Aug;26(3 Suppl 1):S77-87.
Cardiac surgery carries a remarkable risk of blood loss requiring transfusion of blood products. Moreover, severe bleeding necessitating reoperation occurs in 3-5% of patients according to international studies. These patients face a significantly higher morbidity and mortality. This underscores the need for a safe and effective haemostatic therapy, which may significantly improve the outcome. Recombinant activated factor VII is approved for haemophiliacs with inhibitors and patients with thrombasthenia Glanzmann and factor VII deficiency. In the proceeding years a series of articles has been published reporting the successful and safe therapy of refractory bleeding after cardiac surgery. This review focuses at presenting the pathophysiological alterations of the haemostatic system related to the cardiopulmonary bypass. These alterations are thought to explain the high risk of bleeding after cardiopulmonary bypass. Furthermore, the use of rFVIIa in paediatric and adult cardiac surgery is reviewed and critically discussed.
心脏手术存在显著的失血风险，需要输注血液制品。此外，根据国际研究，3%至5%的患者会发生严重出血，需要再次手术。这些患者面临着明显更高的发病率和死亡率。这凸显了对安全有效的止血治疗的需求，这种治疗可能会显著改善治疗结果。重组活化因子VII已被批准用于患有抑制剂的血友病患者、血小板无力症（Glanzmann病）患者以及因子VII缺乏症患者。在过去几年中，发表了一系列文章，报道了心脏手术后难治性出血的成功且安全的治疗方法。本综述重点介绍与体外循环相关的止血系统的病理生理改变。这些改变被认为可以解释体外循环后出血的高风险。此外，还对重组活化因子VIIa在小儿和成人心脏手术中的应用进行了综述并进行了批判性讨论。
