原位肝移植患者围手术期成分输血探讨

目的:探讨原位肝移植围手术期成分输血疗效及手术前血液成分的准备,总结成分输血经验,降低用血量,减少输血反应。方法:44例肝移植患者来自不同的地区,其中1例来自韩国的患者,1例蒙古族患者;2例行肝肾联合移植的患者。部分受体与供体之间有血缘关系,ABO、RH血型相合。将44例肝移植患者按照病情诊断,分为肝硬化组18例(40.1%),男13例、女5例;肝恶性肿瘤组26例(59.1%),男24例、女2例。根据患者手术中、手术后的不同出血情况,给予不同的血液成分治疗,所用红细胞悬液均进行白细胞过滤。结果:肝硬化组成分用血量大于肝恶性肿瘤组(肝癌)。不同病情的肝移植患者需要的血液成分差异很大。讨论:术前明确患者的诊断及病程,探讨患者围手术期的出血量,提供安全、合理、有效的成分输血治疗,应用白细胞过滤技术,减少输血反应,降低输血总量是保障原位肝移植手术取得成功的关键环节。

Analysis of perioperative blood component transfusion in orthotopic liver transplantation patients

Objective:To investigate the curative effect of the perioperative blood component transfusion in orthotopic liver transplantation patients and the preparation of blood component before operations so as to summarize the experience of blood component transfusion and reduce the amount of blood transfusion and the incidence of transfusion reactions.Methods:44 patients from different regions were treated with liver transplantation,among which 1 patient was from the Republic of Korea,1 patient was Mongolian and 2 patients were treated with combined liver-kidney transplantation.Any receptor hadn't blood relationship with his/her donator but their blood types of ABO and RH coincide respectively.According to the diagnosis of pathogenetic condition,44 patients were divided into two groups as follows: hepatic cirrhosis group(n=18),including 13 males and 5 females;and malignant tumor of liver group (n=26),including 24 males and 2 females.The patients were given different blood component transfusion treatment according to their different operative and post-operative hemorrhage condition.All erythrocyte suspensions were used after leukocyte filtration.Results:The hepatic cirrhosis patients needed more amount of blood transfusion than the malignant tumor patients of liver(liver cancer).The blood components which the liver transplantation patients with different pathogenetic conditions needed varied widely.Conclusion:It is the key point of orthotopic liver transplantation success to identify preoperative diagnosis and the course of disease,to investigate perioperative bleeding volume,to provide the safe,reasonable and effective treatment of blood component transfusion and to make use of the leukocyte filtration technology that can reduce the amount of blood transfusion and reduce the incidence of transfusion reactions.