肝癌行肝脏移植术中凝血及血小板功能监测的应用

目的应用Sonoclot分析仪监测肝癌行肝移植手术中患者的凝血及血小板功能,以指导麻醉医师和手术护士及时调整患者凝血功能。方法对肝移植患者的分别在手术开始前、无肝前期、无肝期、新肝期及手术结束前应用Sonoclot凝血及血小板功能分析仪,分析患者的初期凝血形成时间(ACT)、纤维蛋白形成速率(Clot Rate)和血小板功能(platelet func-tion),凝血收缩达峰值时间(time to Peak)。结果在肝脏移植手术前患者除ACT时间延长以外,凝血速率及血小板功能都在正常值的下限,随着供体肝脏的植入,患者的ACT时间延长、Clot Rate降低、TP时间延长、PF降低。与术前比较有显著性差异(P<0.05)。在手术结束前各项凝血指标及血小板功能与术前比较无显著性差异(P>0.05)。结论肝移植手术中以第一时间提供了患者凝血及血小板功能的动态变化情况,既减少了手术护理治疗的盲目性,节约了资源,又为患者的尽早恢复起到一定作用。

The application of monitoring coagulation and platelet function of liver cancer patients during the operation of liver transplantation

Objective Sonoclot analyzer was used to monitor the coagulation and platelet function of liver cancer patients during the operation of liver transplantation,so as to instruct anesthetist and nurse to modulate the coagulation function of patients timely.Methods The patients undergoing liver transplantation were monitored with Sonoclot Coagulation & Platelet Function Analyzer to analyze the activated clotting time(ACT),Clot Rate,and Platelet Function(PF),Time to Peak(TP) before operation,during the preanhepatic phase,the anhepatic phase,neohepatic phase and before the end of operation respectively.Results Before the operation of liver transplantation,except the extension of ACT,the clotting rate and the platelet function of patients were both at the lower limit of normal,but after the donated liver is implanted,the ACT is prolonged,Clot Rate reduced,TP prolonged and PF reduced.All showed significant difference compared with preoperative values(P<0.05).However,all the clotting indices as well as PF before the end of operation showed no significant difference compared with preoperative values(P>0.05).Conclusions During the operation of liver transplantation,closely following the change of clotting and platelet function will reduce the blindness of operative nursing care,save resources and benefit for early recovery of patients.