肝移植围手术期输血的综合评估  

A comprehensive assessment of perioperative blood transfusion in liver transplantation

作　　者：陈波[1] 刘银[1] 刘业[1] 林艳[1] 周晔[1] 唐晓峰[1] 

机构地区：[1]上海长征医院输血科,上海200003

出　　处：《中国输血杂志》2017年第7期711-713,共3页Chinese Journal of Blood Transfusion

基　　金：上海市卫生和计划生育委员会科研课题(2014215);上海市公共卫生重点学科建设项目(15GWZK0501)

摘　　要：目的评估肝移植患者围手术期出血量、血液制剂输注情况。方法回顾性选取119名肝移植患者的病历资料,按年龄、性别、临床诊断(病种)分组,分析患者围手术前、术中和术后24 h的凝血指标,围手术期出血量,以及悬浮红细胞、冰冻血浆、冷沉淀凝血因子、单采血小板的输注情况。结果肝移植患者围手术期出血量及各血液制剂的输注量各项指标:按患者年龄、性别分组比较无明显差异(P>0.05);按临床诊断的不同分组,各诊断组(原发性肝癌组、乙肝肝硬化组及重型肝炎组等)患者单采血小板输注量相近(P>0.05);而悬浮红细胞(U)分别为8.4±11.9、16.2±15.7、18.1±13.5,冰冻血浆(U)分别为8.2±7.1、18.1±15.6、18.2±17.9,冷沉淀(U)分别为9.5±8.2、17.1±16.318.5±16.4等(P<0.05);各诊断组围手术前、术后即时PT(s)分别为15.6±3.8、24.6±4.1,APTT(s)分别为44.3±5.8、84.9±9.2,TT(s)分别为20.4±4.5、40.1±6.2,及Fib(s)分别为2.6±0.8、1.3±0.9,(P<0.05);而各诊断组间患者围手术后24 h PT、APTT、TT及Fib比较无明显差异(P>0.05)。结论临床诊断不同的肝移植患者围手术期血液制剂的输注方案选择的科学、安全、合理对肝移植成功率及患者预后至关重要;各时间段凝血指标检测结果的评估对肝移植围手术期成分输血具有指导作用。Objective To evaluate the perioperative blood loss and blood transfusion in liver transplantation patients. Methods Retrospectively selected and classified 119 patients with liver transplantation medical recordsaccording to the clin- ical diagnosis of age, gender. Analyzed （disease） patients＇ blood coagulation index 24 h before surgery, intraoperative and postoperative perioperative bleeding, and blood red blood cell suspension, frozen plasma, cold precipitation, coagulation factor injection lossplateletpheresis. Results There were no significant differences in the amount of blood loss and the amount of blood preparations duringthe perioperative period of liver transplantation according to the age and sex of patients （ P〉 0. 05） ; According to the clinical diagnosis of different groups, the diagnostic group （ primary liver cancer group, hepatitis B cirrhosis group and severe hepatitis group） patients with a single platelet transfusion dosewas similar （P〉0. 05）withsuspend- ed red blood cells （U） at 8.4±11.9, 16.2±15.7, 18. 1±13.5, frozen plasma （U） at 8.2±7.1, 18.1±15.6 and 18.2± 17.9 respectively andcold precipitation （U） at 9. 5±8.2, 17.1±16. 318. 5±16.4（P〈0. 05） ; The diagnosis group surgery before and after immediate PT （s） were 15.6±3.8, 24. 6±4. 1, APTT （s） were 44. 3±5.8, 84. 9±9. 2, Tr （s） were 20. 4 ±4. 5, 40. 1±6. 2, and Fib（s） were 2. 6±0. 8 and 1.3±0. 9 （P〈0. 05） ;however, there was no significant difference in the 24 h PT, APTT, Tr and Fib between the two groups after diagnosis （P〉0. 05）. Conclusion Aseientific, safe and reasonable selection of perioperative blood preparation for clinical diagnosis for different liver transplantation patients is critical to the success rate and prognosis of liver transplantation; the evaluation of coagulation indexes at each interval can help guiding the blood transfusion during liver transplantation.

关 键 词：输血 肝移植 围手术期 出血量 血液制剂 凝血指标 

分 类 号：R457.1[医药卫生—治疗学] R657.3[医药卫生—临床医学]