凝血和血小板功能指标与肝移植术患儿术后早期血栓形成的关系:Sonoclot分析仪监测  

Relationship between parameters of blood coagulation and platelet function and development of early postoperative thrombosis in pediatric patients undergoing liver transplantation: Sonoclot analyzer monitoring

作　　者：孙英[1] 贾莉莉[1] 朱敏[1] 于洪丽[1] Sudeshnna null 喻文立[1] Sun Ying;Jia Lili;Zhu Min;Yu Hongli;Sudeshnna null;Yu Wenli(Department of Anesthesiology,Tianjin First Center Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院麻醉科,300192

出　　处：《中华麻醉学杂志》2020年第9期1058-1061,共4页Chinese Journal of Anesthesiology

基　　金：天津市第一中心医院院级春风项目(2019CFCF31)。

摘　　要：回顾性分析Sonoclot分析仪监测的凝血和血小板功能指标与肝移植术患儿术后早期血栓形成的关系。收集2019年1月至2020年5月200例行亲体肝移植术的胆道闭锁患儿的病历资料,术后1周内由床旁超声多普勒观察术后早期血栓发生情况,将患者分为血栓形成组和无血栓形成组。将组间比较差异有统计学意义的因素进行logistic回归分析,筛选术后早期血栓形成的危险因素。采用ROC曲线分析缺血再灌注后1 h Sonoclot分析仪监测的ACT用于术后早期血栓形成诊断的准确性。logistic回归分析结果显示,PELD评分、肝脏冷缺血时间和再灌注1 h时ACT是肝移植术患儿术后早期血栓形成的独立危险因素(P<0.05)。Sonoclot分析仪监测的ACT诊断肝移植术患儿术后早期血栓形成的曲线下面积及其95%可信区间为0.92(0.934~0.983),灵敏度为94.7%,特异度为80.2%,最佳截断值为228.5 s。Sonoclot分析仪监测的ACT是肝移植术患儿术后早期血栓形成的独立危险因素;维持ACT≥228.5 s可减少术后早期血栓形成的发生。To evaluate the relationship between blood coagulation and platelet function parameters monitored by the Sonoclot analyzer and development of early thrombosis after liver transplantation in pediatric patients.The medical records of 200 pediatric patients with biliary atresia undergoing elective liver transplantation from January 2019 to May 2020 in our hospital were collected.The development of early postoperative thrombosis was observed by bedside ultrasound Doppler within 1 week after operation.The patients were divided into thrombosis group and non-thrombosis group.The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify early postoperative thrombosis-related risk factors.The ROC curve was used to analyze the accuracy of ACT monitored by the Sonoclot analyzer at 1 h after ischemia-reperfusion for diagnosis of early postoperative thrombosis.The results of logistic regression analysis showed that PELD score,cold liver ischemia time,and ACT at 1 h of reperfusion were independent risk factors for early thrombosis after liver transplantation in pediatric patients(P<0.05).The area under the curve and 95%confidence interval of ACT monitored by the Sonoclot analyzer in diagnosing early postoperative thrombosis in pediactir patients undergoing liver transplantation was 0.92(0.934-0.983),the sensitivity was 94.7%,the specificity was 80.2%,and the best cut-off value was 228.5 s.ACT monitored by Sonoclot analyzer was an independent risk factor for early thrombosis after liver transplantation in pediatric patients,and maintaining ACT≥228.5 s can reduce the development of early thrombosis after liver transplantation.

关 键 词：血液凝固 肝移植 儿童 血栓形成 手术后并发症 

分 类 号：R726.5[医药卫生—儿科]