肝移植术时凝血功能障碍的处理  

Management of coagulation dysfunction during perioperative period of liver transplantation

作　　者：张新友 余小舫 鲍世韵 许瑞莲 郑锦锋 

机构地区：[1]暨南大学医学院第二附属医院深圳市人民医院血液科,广东深圳518020

出　　处：《临床血液学杂志》2008年第1期17-19,共3页Journal of Clinical Hematology

摘　　要：目的:探索同种原位肝移植术(OLT)时凝血功能障碍的诊断与治疗。方法:回顾性分析我院23例次OLT术前和术中凝血功能、术中出血量与输注凝血因子、血小板和红细胞悬液的关系。结果:术前69.6%、56.5%、30.4%肝病患者分别有凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、凝血酶时间(TT)延长,中位延长时间分别为6.3、21.8、6.8s;纤维蛋白原(Fg)和血小板计数(BPC)中位值分别为1.38g/L和47×109/L。术中100%、91.3%、65.2%患者PT、aPTT、TT分别较对照延长,中位延长时间分别为10.3、55.2、18.8s;Fg和BPC的中位值分别为1.26g/L和27×109/L。术前凝血功能正常或纠正充分者16例次,术中血制品用量明显减少,红细胞悬液中位用量4600ml;而术前凝血功能纠正不充分者7例,术中出血量增多,血制品用量也明显增加,红细胞悬液中位用量9000ml。结论:肝移植术加重术中凝血功能障碍;充分的术前准备和动态监测凝血功能并酌情补充血液成分可减少术中出血和输血,以保障手术顺利进行。Objective：To investigate the management of coagulation dysfunction during perioperative period of orthotopic liver transplantation. Method： The changes of coagulation function,the volumes of bleeding and transfusion of blood component were analyzed retrospectively in the 23 patients of liver transplantation in preoperation and intraoperation. Result：A prolongation of prothrombin time （PT）, partial thromboplastin time （APTT） and thrombin time （TT） was observed in 69.6%, 56.5%, 30.4% of the patients with end-stage liver disease in preoperation and in 100%, 91.3%, 65.2% of the patients in intraoperation respectively. The median prolongation time of PT, APTT and TT was 6.3, 21.8, 6.8 seconds in preoperation, and 10.3, 55.2, 18.8 seconds in intraoperation respectively. The median of fibrinogen （Fg） and platelet count was 1.38g/L and 47×10^9/L in preoperation; 1.26 g/L and 27×10^9/L in intraoperation. In the 16 patients whose coagulation function was normal or＇was corrected normally in preoparation, the volume of transfusion of blood component was reduced significantly in intraoparation; The median transfusion volume of red blood cell suspension was 4600 millilitre. In the 7 patients whose coag ulation function was not corrected normally in preoparation, the volumes of bleeding and transfusion of blood com ponent were increased significantly in intraoperation; The median transfusion volume of red blood cell suspension was 9000 millilitre. Conclusion：Coagulation function was deteriorated during intraoperation of liver transplantation. Dynamic monitoring coagulation function and appropriate replacement treatment can reduce the volumes of bleeding and transfusion, and keep stabilization in operation.

关 键 词：凝血功能 终末期肝病 同种原位肝移植 

分 类 号：R617[医药卫生—外科学]