肝移植围手术期凝血功能的变化及调控措施

目的探讨同种异体原位肝移植围麻醉期预处理对凝血功能的影响。方法18例ASAⅢ—Ⅳ级因终末期肝病而行原位肝移植的患者，术前及麻醉诱导后进行预处理，并在不同时期采血检测凝血酶原时间（PT）、活化的部分凝血酶原时间（APTT）、纤维蛋白原（FIB）、D-二聚体（D—dimer）、血小板（PLT）及血清钙离子浓度并进行动态观察。同时应用SONOCLOT凝血及血小板功能分析仪对凝血与血小板功能进行定性分析，记录术中出血量及输血量。结果术中PT、APTT逐渐延长，门脉开放初期达到高峰，新肝再灌注后PT、APTT又逐渐缩短；D—dimer总体上呈现逐渐增加的趋势，再灌注后逐渐下降，但始终高于术前水平。大多数病人全血凝固时间（ACT）在手术开始前即开始延长，新肝期最为突出，新肝后期逐渐缩短。凝结速率（CR）新肝期明显减慢，以后逐渐恢复。血小板功能（PF）在新肝初期最差，到术毕明显恢复。结论肝移植术中的早期预处理，并适时个体化调整有利于改善凝血功能障碍，维持术中的相对稳定，减少术中术后出血和输血。

Study on coagulation change by pretreatment during perianesthetic period of orthotopic liver transplantation

Objective To investigate the effect on coagulation function by pretreatment during perianesthetic period of orthotopic liver transplantation (OLT).Methods 18 patients with end-stage liver disease undergoing OLT,who were pretreated during perianes- thetic period,were monitored by prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinagen (FIB),D-DI- MER,platelet count,and serum calcium.Coagulation and platelet function were qualitatively analysis with Sonoclot,and the volumes of intraoperative bleeding and blood transfusion were reported.Results PT and APTT were prolonged gradually with operation exten- ding,and reached the maxim in early stage of portal vein opening and then PT,APTT reduced after reperfusion,with the value higher than that before operation.ACT was prolonged before in the most patients operation,and decreased after reperfusion;CR obviously be- came slow after reperfusion.PF was deteriorated seriously after reperfusion,and improved at the end of operation.Conclusion Early pretreatment during perianesthetic period in OLT can improve coagulation dysfunction,keep stabilization in operation,and reduce the volumes of bleeding and transfusion.