Sonoclot凝血和血小板功能分析仪监测肝移植术中凝血功能变化的应用

目的 探讨肝移植术中凝血功能的变化和Sonoclot凝血及血小板功能分析仪(sonoct coagution & piatelet function analgzer,SCA)在肝移植术中的应用.方法 24例择期肝移植手术患者全部采用原位经典非转流手术方法.于麻醉诱导前(TO)、手术开始后60 min(T1),无肝期30 min(T2)、新肝期30 min(T3)、新肝期120 min(T4)和术毕(T5)时分别采集桡动脉血检测,硅燥土激活的全血血栓弹性描记图(thrombelastography,TEG),指标包括R值、K值、Alpha角和MA值;玻璃珠激活的全血SCA,指标包括ACT、CR和PF值;常规凝血指标包括PT、APTT、INR、Fbg和Plt.结果 (1)SCA和TEG诊断凝血因子缺乏、纤维蛋白凝胶形成速度和血小板功能(都正常或者都异常)的Kappa值分别是0.371(P<0.05)、0.363(P<0.05)、0.438(P<0.05).gbACT与R、CR与α角、PF与MA呈正相关(r=0.790,P<0.05;r=0.766,P<0.05;r=0.502,P<0.05),CR与K呈负相关(r=-0.588,P<0.05).(2)与T0时比较,T3～T5时PT、INR、gbACT及R延长和FBG、CR、α及MA降低(P<0.05),T1～T5时APTT、T3时K延长(P<0.05),T2～T4时PF降低.结论SCA能够准确地监测肝移植术中凝血功能的变化.

Accuracy of Sonoclot coagulation and platelet function analyzer in monitoring changes of blood coagulation during liver transplantation

Objective To determine intra-operative changes in blood coagulation and the applicability of SCA in liver transplantation. Methods Twenty-four patients with end-stage liver disease undergoing or-thotopic Liver transplantation (OLT) were studied. Arterial blood samples were drawn for determination of celite-activated TEG, glass bead-activated SCA and RCT at 6 intervals: before anesthesia induction (T0), 60 min after operation was started (T1), 30 miu in anhepatic phase (T2), 30 min in neohepatic phase (T3) ,120 min in neohepatic phase (T4) and the end of the operation (T5) ; the variables of TEG includ-ed: reaction time(R) ,coagulation time(K), alpha angles (α) and maximal amplitude (MA) ; the variables of SCA included: activated clotting time (ACT), clot rate (CR) and platelet function(PF) ;RCT included: Plt, PT, INR, APTT, Fbg. Results The Kappa values of SCA and TEG diagnosing the deficiency of blood coagulation factors, the gel formation speed of fibrin and the function of platelet were respectively 0.371 (P < 0.05) ,0. 363 (P < 0.05) ,0.438 (P < 0.05). gbACT and R, CR and α, PF and MA were positive-ly correlative (r = 0. 790, P < 0.05 ; r = 0. 766, P < 0. 05 ; r = 0. 502, P < 0.05 ; respectively) ; CR and K were negatively correlative(r = -0. 588,P <0.05). Compared with T0, PT, INR, gbACT and R were pro-longed, FBG, CR, α and MA were decreased at T3-5 (P < 0.05). APTT was prolonged at T1 ～ T5 (P < 0.05). K was prolonged at T3 (P < 0.05) and PF was decreased at T2 ～ T4. Conclusion SCA can exactly monitor changes of blood coagulation in liver transplantation.