终未期肝硬化肝移植术中凝血功能的调控

目的 探讨终末期肝硬化肝移植术中如何进行合理的凝血系统调控.方法 15例终末期肝硬化肝移植患者,肝功能Child-Pugh评分C级,术前均有不同程度凝血障碍,6例入院时国际标准化比值(INR)＞3.0患者等待肝源期间曾行数次人工肝治疗.术中主要以血液制品进行调控,并注意保温和Ca2 的补充.分别于麻醉后术前、无肝期(下腔静脉阻断后5 min)、新肝期(下腔静脉开放后5 min)、关腹时经中心静脉抽取血标本,进行常规凝血项、血生化、血常规及血栓弹力图(TEG)测定.结果 与术前相比无肝期、新肝期、关腹时白蛋白显著降低(P＜0.05或P＜0.01),其余各项检测指标均无显著改变.结论 终末期肝硬化肝移植术中凝血调控应以新鲜冰冻血浆、血小板为主,必要时补充冷沉淀和纤维蛋白原,加强凝血功能监测,保持适度低凝状态满足临床止血要求即可,切忌盲目追求凝血"正常"而过度治疗,以避免术后血栓栓塞相关并发症的发生.

The regulation of blood coagulation in liver transplant recipients with end-stage cirrhosis

Objective To investigate the appropriate modulation of coagulation function during orthotropic liver transplantation in patients with end-stage hepatocirrhosis.Methods Fifteen patients with end-stage hepatocirrhosis,child-pugh grade C,underwent orthotopic liver transplantation.All of them had coagulation disorder in various degrees.Six of them with preoperative international normalized ratio(INR)>3.0 received artificial liver therapy.Blood preparations were used to modulate coagulation function during operation.Body temperature and serum concentration of Ca2 were also carefully regulated.Blood samples were collected for the measurements of coagulation,biochemical indexes,blood routine test and thromboelastogram at the time points of preoperative phase(T0),anhepatic phase(5 min after inferior vena cava occlusion,T1),neohepatic phase(5 min after inferior vena cava patefaction,T2) and wound closure phase(T3).Results Compared with T0,the albumin concentration at T1,T2,T3 was significantly decreased(P<0.05 or P<0.01),but no statistical differences were found among the other indexes.Conclusion Fresh frozen plasma and platelet should be primarily used to modulate coagulation function during liver transplantation.Cryoprecipitate and fibrinogen are useful if necessary.Coagulation function should be mornitored carefully to maintain it at an appropriate lower level in order to avoid thrombosis after operation.