摘要
目的:探讨不同肝移植术式术中凝血功能变化的规律及相关的影响因素.方法:将2006-06/2007-05我院15例亲体肝移植患者及29例原位肝移植患者,分为肝癌组,肝硬化和急性肝衰组.综合评估患者术前状态,于患者术前及术中(无肝前期、无肝期、再灌注期30 min、再灌注期1 h)检测凝血酶原时间(PT)、活化的部分凝血酶原时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)、血小板计数(PLT)、血红蛋白量(HB)、白蛋白(ALB)及CO_2结合力(TCO_2),观察不同肝移植术式术中各组患者凝血功能及酸碱失衡的变化规律及特点,分析术前和术中可能存在的影响因素及与凝血功能的相关性.结果:肝硬化患者组术前凝血状态介于肝癌组与急性肝衰组之间.术前PLT明显减少,与其他两组相比差异显著(P<0.05).无肝期各项指标进一步恶化.再灌注30 min PT,APTT,INR值达到峰值,FIB水平于无肝期达到最低点(亲体移植:0.68±0.17 g/L vs 0.93±0.37 g/L,0.77±0.19 g/L,0.83±0.27 g/L,0.72±0.31 g/L;原位肝移植:0.65±0.14 g/L vs 0.89±0.10 g/L,0.71±0.26 g/L,0.69±0.16 g/L,0.70±0.23 g/L,P<0.05).肝癌组各指标术前基本正常,术中变化幅度均较前两组小(P<0.05).急性肝衰组患者术前PT、APTT、INR延长最为显著,凝血状态最差(P<0.05),但术中恢复较快.除无肝期外,FIB较其他两组明显减少(P<0.05).应用Pearson相关分析术中出血量与围手术期因素的相关关系,发现MELD评分与术中出血量具有相关性(r=0.619,P<0.05).与原位肝移植相比,亲体肝移植术中凝血功能及代谢紊乱的变化较大,尤以无肝前期及无肝期恶化明显.再灌注后各项凝血指标恢复迅速(P<0.05).结论:应根据具体情况个性化治疗肝移植患者.
AIM： To investigate intraoperative blood coagulation variation and correlative influential factors in liver transplantation.
METHODS： Twenty-nine cases undergoing orthotopic liver transplantation from cadaveric livers from 2006-06 to 2007-05 and 15 cases undergoing living-donor liver transplantation in the same period were studied retrospectively. We assessed prothrombin time （PT）, activated partial thromboplastin time （APPT）, international normalizing ratio （INR）, fibrinogen （FIB）, platelet （PLT）, hemoglobin concentration（Hb）,a lbumin （ALB） and total carbon dioxide （TCO2） during the pro-operation period, dissection period, anhepatic period, early and late neohepatic period, respectively. Changes of every value reflecting blood coagulation function and acidbase metabolism condition were observed in all groups, and fluctuation patterns of all values were studied between periods and groups. Perioperative influential factors were also analyzed. In addition, we compared values of living-donor liver transplantation with orthotopic liver transplantation from cadaveric livers in the same period and studied their correlations.
RESULTS： The average blood coagulation condition of CHC group was between the HCC group and FLF group. In the reperfusion 30 min reperfusion period, PT, AFTT and INR were more abnormal than in any other period of the operation, while FIB level reached its lowest point in the anhepatic stage （Living-donor liver transplantation： 0.68 ± 0.17 g/L vs 0.93 ± 0.37 g/L, 0.77 ± 0.19 g/L, 0.83 ± 0.27 g/L, 0.72±0.31 g/L; Orthotopic liver transplantation： 0.65 ± 0.14 g/L vs 0.89 ± 0.10 g/L, 0.71 ± 0.26 g/L, 0.69 ± 0.16 g/L, 0.70 ± 0.23 g/L, P 〈 0.05）. In the hepatocelluar carcinoma （HCC） group, their relative parameters were almost normal before LDLT and the change span during LDLT was less than those in the other two groups （P 〈 0.05）. Patients in the FLF group were in the worst coagulation state with prolonged PT, AFTT, INR and reduced FIB
出处
《世界华人消化杂志》
CAS
北大核心
2007年第35期3728-3733,共6页
World Chinese Journal of Digestology
关键词
亲体肝移植
原位肝移植
凝血功能
Living-donor liver transplantation
Orthotopic liver transplantation
Blood coagulation
