肝移植患者术前的凝血治疗

目的探讨肝移植患者术前凝血治疗的时机、目标和方法选择.方法回顾性分析我院2002-2004年实施肝移植手术的168例病例资料.统计患者术前凝血酶原时间（PT）、凝血酶原活动度（PTA）、国际标准化比率（INR）、纤维蛋白原（FIB）、活化的部分凝血酶原时间（APTT）、血小板计数（PLT）和相应的凝血治疗措施,术中出血量、各种血制品的用量.分析术前因素与术中出血的关系,PTA分级与术中出血量、术中各种血制品用量的关系,术前血浆置换对术中出血量和术中输血制品量的影响.结果术前PTA趋于正常,术中出血量则少,对于严重凝血障碍的患者,术前应调整PTA至30%以上;术前实施血浆置换可以显著减少重症肝炎患者的术中出血量和血制品用量.结论肝移植患者术前应根据具体情况选择合适的治疗方法,尽量改善患者的凝血状态,以减少术中出血和血制品用量.

A clinical study of perioperative coagulopathy treatment in patients undergoing liver transplantation

Objective To investigate the timing, target and method for the treatment of preoperative coagulopathy in patients undergoing orthotopic liver transplantation. Methods We retrospectively assessed 168 adult patients undergoing orthotopic liver transplantation from 2002 to 2004. Preoperative prothrombin time(PT) , prothrombin activity (PTA) , international normalizing ratio(INR) , activated partial thromboplastin time(APTT) , fibrinogen (FIB) , and platelet count (PLT) were assessed. The relationship between PTA and intraoperative blood loss or use of blood product, preoperative plasma exchange and intraoperative blood loss or use of blood product were analysed. Results Preoperative normocoagulation significantly decreased intraoperative blood loss and blood product' s requirement. PTA level was in negative correlation with intraoperative blood loss and blood transfusion. Preoperative plasma exchange effectively reduced intraoperative bleeding and blood product's requirement. Conclusion Aggressive coagulatory therapy should be adopted to improve coagulation condition in order to reduce intraoperative blood loss and blood product's requirement.