凝血弹性图应用于同种原位肝移植术中凝血功能的评价  

Evaluation of Coagulation in Orthotopic Liver Transplantation with Thrombelastography

作　　者：王晓[1] 罗朝志[1] 王健[1] 文天夫[2] 卢实春[2] 李波[2] 严律南[2] 

机构地区：[1]四川大学华西医院麻醉科,成都610041 [2]四川大学华西医院普外科

出　　处：《中国普外基础与临床杂志》2003年第3期260-262,共3页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的　应用凝血弹性图 (thrombelastograghy ,TEG)监测原位肝移植术中患者的凝血功能 ,指导术中凝血功能的诊断及用药。方法　 2 5例肝移植患者按原发疾病分成两组 ,肝硬变组 15例 ,肝癌组 10例 ,接受原位肝移植术 ,无肝期体外静脉 静脉转流。两组患者分别于术前、无肝期前 (手术开始后 12 0min)、无肝期后 3 0min、新肝期前 5min和新肝期后 5min、15min、3 0min、60min及 12 0min 9个时点 ,分别观察硅燥土激活的全血TEG的参数改变 ,即反映第一块纤维蛋白凝块形成的时间 (r) ,血凝块强度达到 2 0mm振幅的时间 (K ) ,纤维蛋白和血凝块加固速度 (α) ,以及纤维蛋白凝块最终强度 (MA)。 2 5例中有 8例于新肝期后 5min同时观察了肝素酶修正后的TEG的变化。结果　肝硬变组TEG值 4项参数的变化主要发生在无肝期和新肝早期 ,肝肿瘤组TEG值 4项参数的变化均在新肝期后 5min、15min、3 0min及 60min。与术前值相比 ,两组TEG值均表现为r与K延长 ,α与MA减小 (P<0 .0 5 ,P<0 .0 1)。其中 8例新肝期后 5min ,有肝素酶与无肝素酶的全血TEG值差异亦有显著性意义 (P<0 .0 1) ,后者的r和K明显延长 ,α和MA明显减小 ;后者经静脉注射鱼精蛋白 5 0～ 75mg后 ,两组TEG值差异无统计学意义 (P>0 .0 5 )。Objective To evaluate the changes in thrombelastography(TEG) during orthotopic liver transplantation (OLT) in Chinese. Methods Twenty five patients with cirrhosis of liver undergoing OLT were studied. They were composed of two groups: cirrhosis group ( n =15) and liver neoplasm group ( n =10). Anesthesia was induced with propofol 1.5-2 mg/kg,fentanyl 3-5 μg/kg and vecuronium 0.1 mg/kg and maintained with isoflurane or enflurane inhalation.The operation was divided into three phases: ① before operation and preanhepatic phase (120 min after operation was started), ② 30 min after liver was removed,③ 5 min before reperfusion and 5 min,15 min,30 min,60 min and 120 min after reperfusion.In 8 patients among the 25 patients heparinase celite TEG was measured 5 min after reperfusion in addition to celite TEG.If there was significant differences in traces between the two TEG measurements,an intravenous bolus of 50-75 mg protamine was given and the heparinase celite TEG was repeated.The measured variables included the r (reaction) time,representing the rate of initial fibrin formation K (coagulation) time, alpha angles (α) reflecting fibrin platelet interaction, MA (maximal amplitude) indicating qualitative platelet function and percent fibrinolysis at 60 min. Results In cirrhosis group changes in TEG occurred after liver was removed and in earlier period after reperfusion, while in liver neoplasm group changes in TEG were found in earlier period after reperfusion as compared with preoperative value.At 5 min after reperfusion there were significant differences in TEG (r,K,α and MA) values between celite and heparin celite TEG ( P < 0.01) . Conclusion During OLT coagulation disorder occurs mainly at anhepatic and early reperfusion phase.

关 键 词：凝血弹性图 应用 同种原位肝移植术 凝血功能 评价 

分 类 号：R657.3[医药卫生—外科学]