失代偿期肝硬化和急性肝衰竭患者肝移植术中的凝血功能比较与调控  

Comparison and modulation of coagulation function during in orthotopic liver transplantation in patients with decompensated liver cirrhosis and acute liver failure

作　　者：王卓强[1] 徐震[1] 王恒林[1] 

机构地区：[1]解放军第309医院麻醉科,北京100091

出　　处：《中国急救医学》2013年第9期821-825,共5页Chinese Journal of Critical Care Medicine

基　　金：吴阶平医学基金会临床科研专项基金资助项目（320.6750.09107）

摘　　要：目的 观察失代偿期肝硬化（DLC）和急性肝衰竭（ALF）患者肝移植围术期凝血功能的变化,提出调控要点.方法 DLC组39例和ALF组16例患者接受肝移植术.于术前（T0）、无肝前期60 min（T1）、无肝期30 min（T2）、新肝期30 min（T3）和关腹前30 min（T4）五个时点采血测量凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fib）及血小板计数（Plt）,并测定激活凝血时间（ACT）、凝血速率（CR）及血小板功能（PF）.记录失血量、成分输血量和凝血物质用量.结果 两组趋势相近,T1、T2时凝血指标较T0呈轻度稀释性低凝改变;T3时PT、APTT、TT、ACT显著延长,Plt、PF、Fib显著降低（P〈0.05）;T4时除Plt、PF降低明显（P〈0.05）,其余指标均出现不同程度好转.ALF组T0时PT、APTT、TT、ACT比DLC组延长,Plt、PF、Fib比DLC组降低（P〈0.05）,其后经过调控两组数据逐渐趋同,至T4时两组各数据比较差异无统计学意义（P〉0.05）.术中输注血浆和凝血物质的量ALF组大于DLC组（P〈0.05）.结论 ALF组术前凝血功能比DLC组更为恶劣,术中要加大成分输血和凝血物质的用量,两者围术期凝血功能变化趋势一致;经调控最终可达到相近的凝血状态.Objective To observe the changes of coagulation function during liver transplantation in patients with decompensated liver cirrhosis （DLC） and acute liver failure （ALF）, and to provide the essential regulatory factors. Methods Thirty nine patients with DLC and sixteen patients with ALF underwent orthotopic liver transplantation were included in this study. During operation, blood samples were drawn for determination of prothrombin time （PT）, thromboplastin time （TT）, activated partial thromboplastin time （ AI^IT ）, fibrinogen concentration （ Fib ）, platelet count （ Pit ） before operation （To ）, at 60 min during operation （T~）, 30 min after liver removal （T2 ）, 30 min after reperfusion （T3 ） and 30 min before suture （T4 ）. At the same time points, activated clotting time （ACT） of whole blood, clot rate （CR） and platelet function （PF） were monitored by Sonoclot analysis. The amount of blood loss, transfusion of blood component and pro - coagulation drugs were recorded. Results Development tendency of coagulation of two groups were similar. Parameters of coagulation changed as lightly hypocoagulation due to dilution at T1 or T2 compared to TO in both two groups. PT, APTT, TT, ACT were increased significantly, and Pit, PF, Fib were decreased significantly at T3 in both groups （P 〈 0.05）. Normal tendency could be seen in nearly all parameters but for Pit and PF which were decreased significantly at T4 in both groups （P 〈 0.05 ）. The PT, APTT, TT, ACT in ALF group were longer than those in group DLC at To, and Pit, PF, Fib were less than those in DLC group at To （ P 〈 0.05 ）. Therefore, the tendency of these parameters turned to consistent gradually. There was nosignificant difference in the coagulation parameters between the two groups at T4 （ P 〉 0.05 ）. The usage of fresh frozen plasma and coagulant in group ALF were more than those in group DLC （P 〈 0.05 ）. Conclusion The coagulation function in ALF patients is worse than that

关 键 词：急性肝衰竭 失代偿期肝硬化 肝移植 凝血 

分 类 号：R575.2[医药卫生—消化系统]