原位肝移植术中肝素酶修正凝血弹性图的价值  

The value of heparinase-modified thromboelastogram in orthotopic liver transplantation

作　　者：刘克玄[1] 黄文起[1] 陈秉学[1] 黑子清[1] 王钟兴[1] 夏杰华[1] 萧亮灿[1] 

机构地区：[1]中山医科大学附属第一医院麻醉科,广州市510080

出　　处：《临床麻醉学杂志》2001年第12期660-662,共3页Journal of Clinical Anesthesiology

摘　　要：目的　观察原位肝移植术再灌注期肝素酶修正前后的全血凝血弹性图 (TEG)的变化 ,探讨其在鉴别再灌注期凝血障碍原因时的价值。方法　 16例终末期肝病病人择期行原位肝移植术 ,无肝期采用体外静脉 静脉转流。于新肝再灌注前 5分钟及再灌注后 5分钟、12 0分钟同时检测经肝素酶修正后的全血TEG与未经肝素酶修正的TEG(R、R +K、α角、MA)。若两种TEG图形差异明显 ,静脉注射鱼精蛋白并重复检测。上述血样中均加有硅燥土。结果　再灌注前 5分钟及后 12 0分钟 ,肝素酶修正前后的TEG各参数无明显差异 (P >0 0 5 ) ;而再灌注后 5分钟 ,经肝素酶修正与无肝素酶修正的全血TEG各指标值差异显著 ,与前者相比 ,后者R与K明显延长 (P <0 0 1) ,α角与MA明显减小 (P <0 0 5 ) ,其中 13例静脉注射鱼精蛋白 (5 6 4± 40 2 )mg后 ,两种血样TEG各参数差异无显著性 (P >0 0 5 )。结论　肝素酶修正的全血TEG可提示再灌注期体内存在肝素样活动 ,需用鱼精蛋白拮抗 ,在鉴别肝移植术再灌注期异常出血的潜在原因方面具有指导意义。Objective To investigate the value of heparinase modified thromboelastogram (TEG) in the identifying the cause of reperfusion coagulopathy during orthotopic liver transplantation(OLT).Methods 16 patients with end stage liver disease (ESLD) received elective OLT.Veno venous bypass was performed during anhepatic phase.TEG(R?K?α angle?MA)of celited blood with and without heparinase was performed at three time points:at 5min before reperfusion,5min and 120min after reperfusion.If TEG traces of two sorts of blood samples were significantly different,protamine was administered.Results The heparinase traces showed correction of the R and K times and α angle and MA only at 5min after reperfusion.In 13 patients who had TEG performed after protamine administration,there were no differences between TEG traces with and without heparinase.Conclusion Heparinase modified TEG showes a compelling evidence for the presence of heparin like activity after liver graft reperfusion and is useful in identifying the potential causes of reperfusion bleeding in patients undergoing OLT.

关 键 词：肝移植 肝素酶 凝血弹性图 

分 类 号：R614[医药卫生—麻醉学]