Letts M, Pang E, D'Astous J, Jarvis J, Lawton L, Luke B, Rhine E, Menard E
Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
Spine (Phila Pa 1976). 1998 Feb 15;23(4):475-8. doi: 10.1097/00007632-199802150-00014.
A double-blind study comparing the effects of desmopressin and a placebo (normal saline) on blood loss during spinal instrumentation for neuromuscular scoliosis.
To determine the effectiveness of desmopressin acetate (DDAVP) in reducing operative blood loss in hemostatically normal patients undergoing spinal fusion surgery for neuromuscular scoliosis.
Desmopressin acetate has been shown to improve bleeding times and to provide surgical hemostasis in patients with platelet disorders. Its effect in reducing bleeding times in normal patients has been the subject of debate in several surgical specialties. Recent observations that DDAVP seems to reduce bleeding times and blood loss in patients undergoing spinal surgery for neuromuscular scoliosis warranted a more focused analysis on its role in this surgical procedure.
Patients undergoing surgery for neuromuscular scoliosis were randomly assigned to receive DDAVP or placebo. Bleeding times and plasma clotting factors were measured before the administration of the DDAVP or placebo and 60 minutes after. Operative blood loss was carefully measured.
Although the administration of DDAVP decreased overall blood loss by an average of 19% compared with blood loss in the placebo group and blood loss per vertebra fused by an average of 15%, these results were not statistically significant.
Bleeding time and blood loss seem to respond better to DDAVP in some patients, in whom significant decreases were observed, than they do in others. The problem is in identifying those patients in whom a decrease in bleeding time will be elicited after administration of DDAVP. Preoperative administration of DDAVP to such patients should significantly decrease operative blood loss.
一项双盲研究，比较去氨加压素和安慰剂（生理盐水）对神经肌肉型脊柱侧弯脊柱内固定手术期间失血的影响。
确定醋酸去氨加压素（DDAVP）在减少接受神经肌肉型脊柱侧弯脊柱融合手术的止血功能正常患者术中失血方面的有效性。
醋酸去氨加压素已被证明可改善血小板疾病患者的出血时间并实现手术止血。其在减少正常患者出血时间方面的作用在多个外科专业领域一直存在争议。最近的观察表明，DDAVP似乎能减少接受神经肌肉型脊柱侧弯脊柱手术患者的出血时间和失血量，这使得有必要对其在该手术过程中的作用进行更深入的分析。
接受神经肌肉型脊柱侧弯手术的患者被随机分配接受DDAVP或安慰剂。在给予DDAVP或安慰剂之前及之后60分钟测量出血时间和血浆凝血因子。仔细测量术中失血量。
尽管与安慰剂组相比，给予DDAVP使总体失血量平均减少了19%，每个融合椎体的失血量平均减少了15%，但这些结果无统计学意义。
在一些患者中，出血时间和失血量对DDAVP的反应似乎比其他患者更好，在这些患者中观察到了显著下降。问题在于识别那些在给予DDAVP后出血时间会缩短的患者。术前给这些患者使用DDAVP应能显著减少术中失血量。
