抑肽酶对肝移植患者围手术期血液保护的临床研究

目的 研究抑肽酶对肝移植患者围手术期期血液保护的效应.方法 将40例行原位背驮式肝移植术患者随机分为两组:对照组(C组)20例,抑肽酶组(A组)20例.A组首量1 ×106kU,持续量0.25×106kU/h持续静脉泵注抑肽酶,直至术毕,C组泵注等量0.9%氯化钠溶液.于术前(T1)、无肝期前5min(T2)、新肝期5 min(T3)、新肝期30 min(T4)和新肝期120 min(T5)采集颈内静脉血检测凝血功能,包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(TIB)、血栓弹力扫描仪(TEG)的反应时间(R)等.记录两组术中总出血量和血浆、血小板、液体输入量,并记录两组回收血洗涤量和红细胞悬液洗涤量.结果 A组患者术中总出血量、回收血洗涤量、红细胞悬液洗涤量及血浆、白蛋白、胶体输入量[(3708±1910)、(1321±488)、(2121±785)、(2568±904)、(200±63)、(3830±897)ml]明显低于C组[(5676±2241)、(2034±734)、(2697±978)、(3725±1374)、(259±83)、(5065±1505)ml](P<0.01或<0.05).两组T1各凝血功能指标比较,差异均无统计学意义;T2～T5A组的PT、APRR、TT和R均较C组同一时间点缩短(P<0.05或P<0.01).结论 在肝移植术中应用抑肽酶能够有效地改善围手术期期凝血功能,减少术中出血量,减少异体血及血浆代用品的输注量,具有很好的血液保护效应.

A clinical study of aprotinin on perioperative blood conservation in patients undergoing orthotopic liver transplantation

Objective To investigate the effect of aprotinin on perioperative blood conservation in patients undergoing orthotopic liver transplantation (OLT). Methods Forty patients with end-stage liver diseases, undergoing OLT were randomly divided into two groups: aprotinin group received intravenous infusion aprotinin continuously during the whole operation (group A, 20 cases)and control group received the same amount of normal saline instead of aprotinin (group C, 20 cases). Internal jugular vein blood sampleswere collected to measure the coagulation variables including prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), and R value of thrombelastography (TEG) on time points:before skin incision (T1), 5 min in anhepafic phase (T2), 5 min, 30 min and 120 min after reperfusion phase (T3, T4, T5). The volume of total blood loss, red blood cell, blood plasma, platelet and liquid transfusion during operation were observed. Results The volume of total blood loss during operation, blood loss recovery(washed by cell saver)during operation, red blood cell (washed by cell saver) and blood plasma, albumin, colloid liquid transfusion perioperation was (3708 ± 1910),(1321 + 488),(2121 ± 785), (2568 ± 904), (200 ± 63), (3830 ± 897) ml respectively in group A. The matched pair analysis volume was (5676 ± 2241), (2034 ± 734), (2697 ± 978), (3725 ± 1374), (259 ± 83), (5065 ± 1505) ml respectively in group C. Compared with group C, these volume in group A were lower (P < 0.01 or < 0.05). There was no significant difference in each item of coagulation function at T1 time point between the two groups. Each item of coagulation function (PT, APTT, TT and R value of TEG) at T2-T5 time point in group A was better than that in group C (P < 0.05 or < 0.01). Conclusion Aprotinin used in end-stage hver diseases patients during OLT can ameliorate coagulation function, decrease the blood loss perioperation, reduce the amount of homologous blood and blood plasma substitute transfusion, it has a good effect on perioperative blood conservation.