肝移植患者围手术期成分输血分析与评估  

Analysis and evaluation of perioperative blood transfusion in patients suffered liver transplantation

作　　者：李莺[1] 宋志群[1] 熊婷[1] 周小玉[1] 

机构地区：[1]南京医科大学第一附属医院输血科,南京210029

出　　处：《临床血液学杂志（输血与检验）》2016年第6期935-939,共5页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

基　　金：南京市科技计划项目资助(No:201303037)

摘　　要：目的:分析127例肝移植患者在围手术期的成分输血情况,为肝移植术围手术期科学、安全、合理输血提供依据。方法:以回顾性研究方法观察127例肝移植患者成分输血情况及部分患者术后血栓弹力图检测(TEG)结果,分析术前、术中和术后各期悬浮红细胞、新鲜冰冻血浆、血小板、冷沉淀的输注情况。结果:127例肝移植患者围手术期人均输血5 011.5ml,术前占0.5%,术中占76.3%,术后占23.2%;术前、术中、术后悬浮红细胞与新鲜冰冻血浆的比例分别为1.38∶1.00,1.58∶1.00,1.17∶1.00。不同基础疾病组患者术前血红蛋白水平、血小板计数和凝血指标存在差异,其中肝炎后肝硬化组血红蛋白值、血小板计数均显著低于原发性肝癌组;肝炎后肝硬化组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)显著长于原发性肝癌组,纤维蛋白原含量低于原发性肝癌组;不同基础疾病影响肝移植围术期成分输血量,其中肝炎后肝硬化组术中输注血浆、冷沉淀及血小板较原发性肝癌组显著性增多;肝炎后肝硬化组术后输注冷沉淀及血小板较原发性肝癌组显著性增多。127例肝移植患者中有46例接受术后TEG检测,结果提示患者为低凝状态,主要表现为纤维蛋白原活性降低、血小板活性降低,其中肝炎后肝硬化组凝血因子活性及纤维蛋白原功能均低于原发性肝癌组。结论:针对不同基础疾病所致肝移植术围手术期,选择科学、安全、合理的输血方案对肝移植成功率及患者预后至关重要,TEG检测对肝移植围手术期成分输血具有指导作用。Objective：To analyze 127 cases of liver transplantation patients＇ blood component transfusion in perioperative period,so as to provide the evidence for scientific,safe and reasonable liver transplantation transfusion in perioperative period.Method：With retrospectively analyzed methods,the 127 cases of liver transplantation patients＇ blood component transfusion situation of this hospital were observed,and preoperative,intraoperative and postoperative red blood cells suspension,fresh frozen plasma,platelet and cryoprecipitate transfusion were analyzed.Result：The average transfusion volume of 127 cases of liver transplantation patients＇ blood component transfusion was 5 011.5ml,preoperative,intraoperative and postoperative period accounted for 0.5%,76.3%,and23.2%,respectively.The ratios of red blood cells suspension to fresh frozen plasma in preoperative,intra-operative,postoperative period were 1.38∶1.00,1.58∶1.00 and 1.17∶1.00,respectively.There were differences on pre-operative hemoglobin level,platelet count and coagulation index between different basic disease groups.Post-hepatitic cirrhosis group had lower level of Hb value and platelet count than those of primary liver cancer group.The prothrombin time（PT）and activated partial thromboplastin time（APTT）of posthepatitic cirrhosis group were significantly longer than those of primary liver cancer group,and lower fibrinogen content than that of primary liver cancer group.Different basic diseases affected liver transplantation perioperative period blood component transfusion volume.The intraoperative plasma,cryoprecipitate and platelet transfusion in posthepatitic cirrhosis group significantly increased compared with primary liver cancer group;and the postoperative cryoprecipitate and platelet transfusion in posthepatitic cirrhosis group were significantly more than those of primary liver cancer group.Post liver transplantation thrombelastography（TEG）results suggested that patients with low coagulation state mainly represented as the

关 键 词：肝移植:成分输血 血栓弹力图 

分 类 号：R617[医药卫生—外科学]