目的:探讨重组活化人凝血因子Ⅶ(rFⅦa)治疗老年外科难控制性大出血患者的临床疗效及安全性。方法:回顾性分析北京医院外科重症监护病房(ICU)2004年5月至2018年12月应用rFⅦa成功治疗的27例老年外科围术期难控性大出血患者的病历资料，并总结其应用方法和经验。结果:27例患者中23例患者停止出血，痊愈16例，共有11例死亡，总体病死率为40.74%(11/27)；其中因出血未得到有效控制而死于出血者4例，故出血病死率为14.81%(4/27)；出血控制后死于原发疾病者7例，病死率为25.93%(7/27)。应用rFⅦa后凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶原国际时间(INR)等指标均显著低于用药前，差异均具有统计学意义(n Z＝－2.197、－3.180、－2.271、－2.803，n P＝0.028，0.001，0.023、0.005)；而应用rFⅦ后患者凝血酶原活动度(AT)显著高于用药前，差异有统计学意义(n Z＝2.756，n P＝0.006)。n 结论:针对老年患者，对于外科难控制性大出血在传统措施治疗无效的情况下，应用rFⅦa治疗可取得较好的效果。“,”Objective:To investigate the efficacy and safety of recombinant activated factor Ⅶ(rFⅦa)on uncontrolled perioperative hemorrhage in elderly patients in surgical intensive care unit(SICU).Methods:Clinical data of 27 elderly patients with uncontrolled perioperative hemorrhage treated successfully with rFⅦa in surgery-ICU of our hospital from May 2004 to December 2018 were retrospectively analyzed.And the application method and experience were summarized.Results:Of the 27 patients, 16 cases were cured, 11 cases died, and the total fatality rate was 40.74%(11/27). The bleeding stopped in 23 cases, four cases died of uncontrolled peri-operative hemorrhage, and the hemorrhage-caused fatality rate was 14.81%(4/27). Seven patients died of primary diseases after the control of bleeding, with a fatality rate of 25.93%(7/27 ). The thrombin time(TT), prothrombin time(PT), activated partial thromboplastin time(APTT)and international normalized ratio(INR)were reduced and the prothrombin activity(AT)was increased after versus before the application of rFⅦa(n Z=-2.197, -3.180, -2.271, -2.803 and 2.756, n P=0.028, 0.001, 0.023, 0.005 and 0.006, respectively).n Conclusions:rFⅦa has a better effect on uncontrolled peri-operative hemorrhage in elderly patients, when traditional treatments are ineffective.