重症肝炎患者在肝移植围术期的凝血功能管理(附39例总结)  

Management of blood coagulation function in patients with severe hepatitis during perioperative period of liver transplantation(a summary of 39 cases)

作　　者：蒋红梅 杨博[1] 张波[1] 代辰 魏来[1] 陈知水[1] 陈栋[1] Jiang Hongmei;Yang Bo;Zhang Bo;Dai Chen;Wei Lai;Chen Zhishui;Chen Dong(Institute of Organ Transplantation,Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Key Laboratory of Organ Transplantation,Ministry of Education,Ministry of Public Health,Chinese Academy of Medical Sciences,Wu Han 430030,Hu Bei,China)

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所,器官移植教育部重点实验室,国家卫生健康委员会器官移植重点实验室,中国医学科学院器官移植重点实验室,湖北武汉430030

出　　处：《实用器官移植电子杂志》2021年第5期354-358,共5页Practical Journal of Organ Transplantation(Electronic Version)

摘　　要：目的探讨重症肝炎患者在肝移植围术期的凝血功能变化的观察及管理。方法回顾性分析2018年1月至2021年3月因重症肝炎收治本院接受同种异体肝移植手术的39例肝移植受者的临床资料,分别在术前(T0)、移植后3 h(T1)、术后24 h(T2)、术后72 h(T3)几个时间段,检测凝血酶时间(prothrombin time,PT)、凝血酶原时间活动度(prothrombin time activity,PTA)、国际标准化比值(international normalized ratio,INR)、血小板计数(platelet count,PLT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,FIB)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)等指标。并记录肝移植术中凝血物质用量、手术时间、出血量及血液制品用量。结果相比于术前,凝血物质使用后,PT值及APTT值逐渐下降(P<0.05),术后72 h恢复正常。相较于术前,使用凝血物质后,PTA值和FIB值逐渐上升至正常范围(P<0.05)。结论重症肝炎患者凝血功能差,肝移植手术时间长而复杂,术中密切观察患者出血情况,监测凝血功能,及时补充相应的凝血物质以保证手术顺利进行有重要意义。Objective To investigate the observation and management of blood coagulation function in patients with severe hepatitis during perioperative period of liver transplantation.Methods The blood coagulation functions of 39 patients with severe hepatitis who underwent allogeneic liver transplantation in our hospital from January 2018 to March 2021 were retrospectively analyzed.Blood coagulation markers,such as thrombin time(PT),prothrombin time activity(PTA),international standardized ratio(INR),platelet count(PLT),thrombin time(TT),fibrinogen(FIB)and activated partial thromboplastin time(APTT),were measured before transplantation(T0),3 hours after transplantation(T1),24 hours after operation(T2)and 72 hours after operation(T3).The dosage of clotting substance,operation time,volume of blood loss and volume of blood products during liver transplantation were recorded.Results Compared with preoperative values,the values of PT and APTT decreased gradually after the use of coagulant substances(P<0.05),and returned to normal 72 hours after operation.The values of PTA and FIB gradually increased into the normal range after the use of coagulant substances(P<0.05).Conclusion The coagulation function of the patients with severe hepatitis is poor,and the operation time of liver transplantation is long and complicated.It is of great significance to closely observe the bleeding of the patients,monitor the blood coagulation function and supplement the corresponding coagulation substances in time to ensure the smooth progress of the operation.

关 键 词：重症肝炎 肝移植 围术期 凝血功能管理 

分 类 号：R657.3[医药卫生—外科学]