尖吻蝮蛇血凝酶不同用法用量在乳腺良性肿块麦默通围手术期应用的对比研究

目的 比较尖吻蝮蛇血凝酶(Haemocoagulase Agkistrodon,HCA)不同用法用量在预防乳腺良性肿块麦默通(Mammotome,MMT)微创旋切术围手术期出血的应用疗效、安全性及经济性.方法 收集我医院胸外乳腺科2016年4-9月住院的乳腺良性肿块行MMT微创旋切术治疗的患者75例,其中MMT术前使用尖吻蝮蛇血凝酶2 U的患者35例纳入A组,MMT术前术后分别使用尖吻蝮蛇血凝酶1 U的患者40例纳入B组,比较两组的平均术中出血量、术后血肿发生率、不良反应发生率、平均住院天数、平均住院药物费用和平均住院给药费用,并进行成本-效果分析.结果 两组之间平均术中出血量、术后血肿发生率、治疗有效率、不良反应发生率、平均住院天数和平均住院药物费用比较差异均无统计学意义(P>0.05),但B组的平均住院给药费用高于A组(P<0.05),A组具有成本-效果优势.结论 尖吻蝮蛇血凝酶术前使用2 U与术前术后分别使用1 U在预防乳腺良性肿块MMT微创旋切术围手术期出血应用中具有相似的疗效及安全性,但术前术后分别给1 U增加患者的平均住院给药费用,经济性较差.

Comparative study of different dosages and usages of HCA apply to benign breast tumor in perioperative period with Mammotome system

Objective To compare the hemostatic efficacy,safety and economy of different dosages and usages of Haemocoagulase Agkistrodon(HCA) apply to prevent perioperative bleeding of breast benign tumor with Mammotome (MMT) system.Methods Seventy-five patients with breast benign tumor underwent minimally invasive MMT resection from April to September in 2016 were assigned to group A (HCA 2 U before MMT,35 cases) and group B(HCA 1 U before and after MMT,40 cases).The average intraoperative mean blood loss,incidence of postoperative hematoma and adverse reactions,average length of hospital stay,inpatient drug costs and administration costs were investigated and the cost-effectiveness analysis were conducted.Results There was no significant difference between the two groups in the intraoperative mean blood loss,the incidence of postoperative hematoma,treatment effective rate and adverse reactions,average length of hospital stay inpatient drug costs and inpatient drug costs (P>0.05),but the average administration costs of group B was significantly higher than group A (P<0.05),group A shows cost-effectiveness advantage.Conclusion Different dosages and usages of HCA had similar efficacy and safety for the treatment of benign breast tumor with MMT minimally invasive resection,however,administration of HCA 1U before and after MMT increased the average inpatient administration costs which with poor economic nature.