乌司他丁对肝移植术患者凝血功能的影响

目的 评价乌司他丁对肝移植术患者凝血功能的影响.方法 拟行原位肝移植术的终末期肝病患者20例,年龄36～59岁,ASA Ⅲ或Ⅳ级,随机分为2组:对照组(C组)和乌司他丁组(U组).U组切皮后静脉输注乌司他丁2万U/min,持续1 h,乌司他丁输注量120万U(加入400 ml生理盐水中),每隔4 h重复输注;C组给予等容量生理盐水.分别于麻醉后切皮前、无肝前期30 min、无肝期30 min、新肝期30 min和术毕时采集中心静脉血样,测定Sonoclot凝血功能指标、常规凝血功能指标及血浆Ca2+浓度,记录术中出血量、输血量及术后24 h引流量.结果 与麻醉后切皮前比较,两组凝血酶时间、凝血酶原时间、活化部分凝血活酶时间、激活凝固时间延长,纤维蛋白原浓度、Ca2+浓度、纤维蛋白凝集率和血小板功能降低,C组D-二聚体浓度升高(P<0.05);与C组比较,U组D-二聚体浓度降低,血小板功能增强,术后24 h引流量降低(P<0.05),其余指标差异无统计学意义(P>0.05).结论 术中静脉输注乌司他丁可改善肝移植术患者凝血功能,减少术后出血.

Effect of ulinastatin on coagulation function in patients undergoing orthotopic liver transplantation

Objective To evaluate the effect of ulinastatin on coagulation function in patients undergoing orthotopic liver transplantation (OLT). Methods Twenty ASA Ⅲ or Ⅳ patients with end-stage liver diseases undergoing OLT, aged 36-59 yr, were randomly divided into 2 groups (n = 10 each): control group (group C) and ulinastatin group (group U). Group U received iv infusion of ulinastatin 2 × 104 U/min for 1 h (ulinastatin 12 × 105 U in 400 ml normal saline) after skin incision and repeated every 4 h. Group C received the same volume of normal saline instead of ulinastatin. Anesthesia was induced with midazolam 0.05-0.1 mg/kg, etomidate 0.3 mg/kg, fentanyl 5 μg/kg, and vecuroninm 0.1 mg/kg and maintained with isoflurane inhalation (end-tidal concentration 0.3%-0.6%) and intermittent iv boluses of feutanyl 2-3 μg/kg and vecuronium 0.5 mg/kg and iv phase, 30 min of anbepatic phase, 30 min of neohepatic phase for determination of Sonoclot and routine coagulation function and plasma Ca2+ concentration. Blood loss and transfusion volume during operation, and 24-h drainage flow after operation were recorded. Results Compared with the values before skin incision, thrombin time, prothrombin time, activated partial thromboplastin time, activated clotting time were prelonged, and concentrations of fibrinogen and plasma Ca2+, fibrinogen clotting rate and platelet function decreased in both groups, and D-direct concentration was significantly increased in group C (P<0.05). D-dimer concentration was significantly lower, platelet function higher and 24-h drainage flow after operation lower in group U than in group C (P<0.05), but there were no significant differences in the other indices between group U and C (P>0.05). Conclusion Intravenous infusion of ulinastatin during operation can improve coagulation function and reduce postoperative blood loss in patients undergoing OLT.