肝脏移植围麻醉期凝血功能的监测与调控

目的　探讨同种异体原位肝脏移植围麻醉期凝血功能的变化规律和检验治疗效果。方法　对 10名患者围麻醉期不同阶段的凝血酶原时间 (PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原 (FIB)、血小板 (PLT)、血红蛋白(Hb)、凝血和血小板功能进行动态观察。结果　围麻醉期在充分补充新鲜冰冻血浆的基础上 ,根据检测结果有选择性地应用凝血酶原复合物、纤维蛋白原、血小板、止血剂 ,至手术结束时患者的凝血状况得到了明显改善 ,与术前相比差异显著 (P <0 0 1) ,但仍在正常低限 ,全部患者无一例因出血和血栓再次手术。结论　手术中应对凝血功能进行适时监测与调控 ,围麻醉期要处理好新肝吻合口局部的高凝与全身低凝的关系 ,预防术后出血、肝动脉和 (或)门静脉血栓。

MONITOR AND MODULATION OF COAGULATION DISORDER DURING THE OPERATION OF LIVER TRANSPLANTATION

Objective To monitor and modulate the coagulation disorder during operation in patients undergiong allogeneic liver transplantation. Methods PT, TT, APTT, FIB, HB, PLT count, sonoclot coagulation and platelet function were measured dynamically in 10 patients during anesthesia and operation. Results After coagulants were used, the above parameters pertaining to coagulation function were improved obviously. All of above coagulation parameters were severely abnormal in the period from 30 minutes before anesthesia to 20 minutes after portal vein recirculation. The hypocoagulability was significantly improved at the end of operation by target supplementation of prothrombin complex, fibrinogen, fresh platelets, and other coagulants, complementing large amount of fresh blood plasma. Notably, severe hemorrhage and thrombosis leading to re-operation did not happen in all the recepients. Conclusion The relationship of the local hypercoagubility at the anastomosis and the systemic hypocoagulation should be concerned to prevent coagulation and thrombosis during operation of liver transplantation.