肝移植围术期纤溶酶活性及α2-抗纤溶酶活性变化  

Changes of Activity of Fibrinolysin and Alpha 2-antiplasmin in Patients Undergoing Orthotopic Liver Transplantation

作　　者：甘小亮[1] 黎尚荣[1] 黑子清[1] 卢振和[2] 葛缅[1] 罗刚健[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广东广州510630 [2]广州医学院附属第二医院麻醉科,广东广州510260

出　　处：《中山大学学报（医学科学版）》2006年第3期342-345,共4页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：目的观察肝移植围术期纤溶酶活性及α2-抗纤溶酶活性的变化。方法19例患者分为重型肝炎组(H组,8例)与肝肿瘤组(N组,11例),接受原位肝移植术,均未采用体外静脉-静脉转流。两组患者分别于术前(T0)、手术1h(T1)、无肝10min(T2)、新肝5min(T3)、关腹前30min(T4),5个时间点,抽取动脉血测定纤溶酶活性及α2-抗纤溶酶活性,并记录各时段促凝抗纤溶药物的用量。结果两组患者纤溶酶活性在T2、T3和T4与T0比较明显增强(P<0.05);α2-抗纤溶酶活性在T1、T2和T4与T0比较明显增强(P<0.05)。两组之间纤溶酶活性H组强于N组(P<0.05);α2-抗纤溶酶活性组间比较差异无统计学意义(P>0.05)。H组所用的血小板数量、抑肽酶及重组活化因子Ⅶ(rFⅦa)多于N组(P<0.05)。Child-pugh评分与术前α2-抗纤溶酶活性呈负相关(r=-0.643,P=0.003)。结论①两组在无肝期及新肝早期出现纤溶活性增强,但所需的促凝抗纤溶物质H组多于N组。②Child-pugh评分与术前α2-抗纤溶酶活性呈负相关。[Objective] To observe the changes of activity of fibrinolysin and alpha 2-antiplasmin or α2- plasmin inhibitor（α2-PI） in the patients undergoing orthotopic liver transplantation （OLT）. [Methods] Nineteen patients with end-stage liver disease undergoing OLT were studied. They were composed of two groups： severe hepatitis group （n=8） （group H） and liver neoplasm group （n=l 1） （group N）. All patients were not received venovenous bypass. Arterial blood samples were drawn an existing arterial line for determination the activity of fibrinolysin and α2-PI at 5 intervals： before induction （To）, 60 min after operation was started （T1）, 10 min after liver was removed （T2）, 5 min after reperfusion （T3）, and 30 min before abdominoperitoneal was closed （T4）. All the coagulant and anti-fibrinolytic drugs in each phase were recorded. [Results] Compared with To, the activity of fibrinolysin increased significantly at T2, T3 ,T4 in the two groups （P〈 0.05）, and the activity of α2-PI increased significantly at T1, T2, and T4 compared with To in the two groups （P〈 0.05）. The activity of fibfinolysin was higher in group H than in group N （P〈0.05） , while there was no significant difference in the activity of α2-PI between two groups（P 〉0.05）. The usage of coagulant and anti-fibrinolytic drugs were significant different in two groups（P〈 0.05）. There was negative correlation between the activity of α2-PI and Child-Pugh score in the two groups （r=-0.643 ,P=- 0.003）. [Conclusions] （1） There will occur hyperfibrinolysis at anhepatic and early reperfusion phase during OLT, but the usage of coagulant and anti-fibfinolytic drugs in group H were more than those in group N. （2） A negative correlation exists between activity of α2-PI and Child-Pugh score.

关 键 词：肝炎 肝移植 凝血 纤维蛋白溶解 

分 类 号：R614[医药卫生—麻醉学]