3种蛇毒类凝血酶制剂在外科手术的止血作用和经济学研究

目的：探讨3种蛇毒类凝血酶制剂在外科手术的止血有效性，并进行经济学分析，为临床选择最佳止血方案提供依据。方法：回顾性抽取2015年1月-2016年1月在某院骨科腰椎手术及四肢骨折内固定术选用单一止血药注射用白眉蛇毒血凝酶（邦亭）、蛇毒血凝酶注射液（速乐涓）和注射用矛头蛇毒血凝酶（巴曲亭）的手术病例303例进行临床疗效和经济学研究。结果：邦亭、速乐涓和巴曲亭在腰椎手术及四肢骨折内固定术的止血临床有效率分别为76.31%，81.08%，75.00%和72.13%，76.92%，73.33%，两两比较均无统计学差异（P>0.05）。不良反应发生率比较，差异性无统计学意义（P>0.05）。采用最小成本分析法进行经济学分析，3组患者除蛇毒血凝酶制剂费用和处理不良反应费用外的所有费用基本相等。邦亭组、速乐涓组和巴曲亭组及处理不良反应的费用在腰椎手术及四肢骨折内固定术分别为384.7，451，1 189.1，443，506.1，1 223.4元，两两比较结果显示，邦亭组与速乐涓组比较均无显著性差异（P>0.05），巴曲亭组分别与邦亭组与速乐涓组比较均存在显著性差异（P<0.05）。结论：注射用白眉蛇毒血凝酶（邦亭）和蛇毒血凝酶注射液（速乐涓）用于腰椎手术及四肢骨折内固定术术中止血的经济性明显优于注射用矛头蛇毒血凝酶（巴曲亭）。

Hemostatic effects and economics study of three different snake venom thrombin-like enzyme (SVTLE) preparations for surgery patients

OBJECTIVE To study the hemostatic effect and economics of three different snake venom thrombin-like enzyme (SVTLE) preparations for surgery patients.METHODS Totally 303 patients received lumbar spine surgery and limb fracture internal fixation surgery were enrolled from January 2015 to January 2016, all patients had only one of hemocoagulase for injection (Bangting), hemocoagulase injection (Sulejuan) or hemocoagulase bothrops atrox for injection (Baquting). Clinical efficacy and economics of the above SVTLE preparations were investigated.RESULTS Effective rates of Bangting, Sulejuan and Baquting in patients received lumbar spine surgery and limb fracture internal fixation surgery were 76.31%, 81.08%, 75.00% and 72.13%, 76.92%, 73.33%, respectively. No significant difference was observed in effective rate or in rate of adverse drug reactions(P>0.05). Economic analysis was performed by using the minimum cost analysis, except for expenses for hemocoagulase preparations and treatments against adverse reactions, the other costs were substantially equal in three groups. Drug costs of Bangting, Sulejuan and Baquting were 384.7 yuan, 451 yuan, 1 189.1 yuan and 443 yuan, 506.1 yuan, 1 223.4 yuan respectively in patients received lumbar spine surgery and limb fracture internal fixation surgery. The results of statistical comparisons showed no significant difference between Bangting group and Sulejuan group (P>0.05), but significant difference between Baquting group and Bangting group or Sulejuan group (P<0.05).CONCLUSION The economics of hemocoagulase for injection (Bangting) and hemocoagulase injection (Sulejuan) are obviously superior to those of hemocoagulase bothrops atrox for injection (Baquting) in patients received lumbar spine surgery and limb fracture internal fixation surgery.