重症肝炎肝移植围术期应用抑肽酶对血管活性药物和输血输液需求的影响

目的探讨重症肝炎患者肝移植围术期应用抑肽酶对血管活性药物和输血输液需求的影响。方法重症肝炎40例随机分为抑肽酶组:微泵持续输入抑肽酶(4×106)U/h;对照组:输等容量生理盐水。观察两组患者肝移植围术期血流动力学、血液丢失量、输血和输液总量、血管活性药物用量、术后引流量、红细胞压积等临床情况。结果两组患者同一时间点的血流动力学和红细胞压积无显著性差异;抑肽酶组手术各期出血量和总出血量明显低于对照组(P<0.05),红细胞、血浆、血小板和液体输入量明显少于对照组(P<0.05);抑肽酶组无肝期和新肝期多巴胺、新肝期肾上腺素用量均少于对照组(P<0.05);两组去甲肾上腺素用量无显著性差异。结论重症肝炎肝移植围术期应用抑肽酶,可显著减少围术期失血、减少血液和液体的输注量,一定程度减少血管活性药物的需求。

Effect of Aprotinin on perioperative vasopressor use, blood and liquid requirement in severe hepatitis patients undergoing liver transplantation

Objective To study the effect of Aprotinin on the perioperative requirement of vasopressor,blood transfusion and liquid infusion in severe hepatitis patients undergoing liver transplantation.Methods Forty severe hepatitis patients were randomly assigned into two groups.Aprotinin group: Aprotinin was continuously infused(4×10~6)U/h by micropump.Control group: infused equal volume of Saline.The hemodynamic parameters,blood loss,volume of blood and liquid transfusion,doses of vasopressor,Hct and postoperative drainage volume were measured.Results There was no significant difference in hemodynamic and Hct at each time-point between the two groups.Compared with control group,in Aprotinin group,the total blood loss and that at each stage of operation were smaller(P<0.05),the perioperative transfusion of red cells,plasma,platelets and liquid were significant decreased(P<0.05).The dose of dopamine used in anhaptic and newhaptic phases was lower(P<0.05),and the dose of adrenaline used in newhepatic phase was lower than that in the control group(P<0.05).The dose of noadrenaline used showed no significant difference between the two groups.Conclusion Aprotinin can reduce the blood loss during liver transplantation in severe hepatitis patients,and it can also reduce blood transfusion and liquid infusion and the dosage of vasopressor.