再次肝移植围手术期输血治疗的探讨

目的探讨再次肝移植患者围手术期输血治疗及血液保护的规律与经验。方法随机抽取行两次肝移植手术患者12名,观察患者第1次与第2次手术间各指标差别,包括术前凝血功能、手术用时、血液丢失量、各类血液成分输入量、输液总量及临床预后等。结果2次手术术前凝血功能、所用时间、手术方式、无肝期时间、总入液量、总出液量及冷沉淀输入量无统计学差异(P>0.05);再次移植术中血液丢失量、红细胞悬液、血浆及血小板输入量明显增多(P<0.05)。结论在肝移植围手术期应根据患者的病情选择适当的血液制剂输注,合理应用相应的血液保护措施,并对凝血功能动态检测、恰当纠正,降低失血和输血量,提高肝移植患者的存活率。

Perioperative blood transfusion of liver retransplantation

Objective To study the perioperative blood transfusion in the patients undergoing orthotopic liver retransplantation(OLR).Methods Twelve OLR patients,from July 2004 to July 2007,were analyzed retrospectively.The hemodynamics,preoperative blood coagulation function,surgical time,volume of blood loss and blood transfusion,and prognosis of patients between primary liver transplantation(PLT)and OLR were analyzed.Results There were no statistical differences between PLT and OLR in perioperative coagulation function,surgical time,surgical procedure,anhepatic phase,volume of cryoprecipitate transfusion,the total volume of fluid loss and fluid infusions.The volume of blood loss,transfusion of red blood cell suspensions,fresh frozen plasma and platelets were significantly larger in OLR than those in PLT.Conclusion Choosing the appropriate blood products,practicing blood conservation,and monitoring the coagulation function during perioperative period are important to decrease the amount of blood loss and blood transfusion,and possibly increase the survival rate of OLR patients.