肝移植术后凝血功能动态观察及临床意义

 目的 动态观察原位肝移植(OLT)术前、后 5项凝血指标的变化,探讨其临床意义.方法 检测41例终末期肝病患者OLT术前和术后1～7 d的凝血酶原(PT)、活化部分凝血活酶(APTT)、纤维蛋白原(Fbg)、凝血酶(T T)、抗凝血酶(AT-Ⅲ).结果 肝移植患者普遍术前凝血机制差,术后1～3 d ,PT、APTT延长,Fbg、ATⅢ减低,3 d后凝血功能逐渐恢复.各种术后并发症可影响凝血功能恢复,尤其是出血或血栓发生.结论 肝移植患者术后凝血功能恢复与多种因素有关,包括术前仔细评估肝脏凝血功能并进行纠正,术中肝动脉重建的外科技术 ,术后根据病情调整凝血紊乱,积极防止血栓和出血的发生.

Clinical significance of five coagnlation-related indexes after orthotopic liver transplantation

Objiective To study the clinical significance of dynamically observetd 5 indexes related to coagulation function before and after orthotopic liver transplantation（OLT）. Methods Forty - one patients with end stage liver disease undergoing OLT were monitored for pmthrombin time （PT）, activated partial thromboplastin time （ APTT）, fibrinogen （Fbg）, thrombin time （TF）, and antithrombin Ⅲ（ AT Ⅲ ） before and on first to seventh day after OLT. Results Before operation coagulation was deteriorated seriously in most pationts. PT and APTT were prolonged,and Fbg and ATⅢ decreased on days 1 - 3 after operation;the five indexes were improved gradually followring the third day.Hemorrhage and thrombosis might affect recovery of coagulation function. Conclusions Careful preoperative evaluation and intraoperative microsurgical technique for hepatic artery reconstruction are key factors in prevention of hepatic artery complications after OLT. Severe hemorrhage due to coagulstion disorders should be prevented after OLT.The combined theranv for correction of coagulation disorder should be annlied.