摘要
目的:比较肝硬化合并肝癌患者和病毒性肝炎肝硬化患者在行肝移植手术中凝血功能的变化,以更好地调控围术期的凝血功能.方法:对实施肝移植术的37例肝硬化合并肝癌患者(肝癌组)和40例病毒性肝炎肝硬化患者(肝硬化组),于麻醉后术前(Ⅰ期)、无肝期开始(Ⅱ期)及新肝期90min(Ⅲ期),用凝血弹性描记图(TEG)分别测定各期R值、K值、MA值及α角,同时记录手术中各期患者的出血量及血制品用量.结果:Ⅰ期和Ⅱ期中,肝癌组与肝硬化组相比,MA值、α角增大,术中出血量相对较少,Ⅰ期所需新鲜冰冻血浆量也少于后者(P<0.05);Ⅲ期中,两组患者的凝血功能都有所降低,均出现R值延长、MA值及α角减小,但肝癌组所需新鲜冰冻血浆和红细胞数量要明显少于肝硬化组(P<0.05),并且两组指标分别与各自术前相比,也有显著性差异(P<0.05).结论:肝癌组患者的凝血功能在肝移植术术前、术中均好于肝硬化组;出血量和所需的血制品也要少于肝硬化组.
AIM： To compare the coagulative function between patients with cirrhosis complicated with hepatocellular carcinoma （HCC） and patients with liver cirrhosis so as to modulate the perioperative eoagulative function more effectively. METHODS： In 37 patients of liver cirrhosis complicated with HCC （ group C ） and 40 patients with simple liver cirrhosis（ group V）, who were undergoing liver transplantation, TEG was employed to determine the R, K and MA values and α angle after anesthesia（ phase Ⅰ ） , anbepatic phase （ phase Ⅱ ） and 90 rain after neohepatic phase （ phase Ⅲ ）. Blood loss and consumption of blood products in the 3 phases were recorded. RESULTS： In phase Ⅰ and Ⅱ, the MA value and et angle of group C were significantly higher than those in group V, the blood loss in group C was markedly lower than that in group V and the volume of transfused blood products （FFP） in phase l in group C was lower than that in group V （P 〈 0.05 ）. In phase Ⅲ, the eoagulative function in both groups reduced. The R value was higher but MA value and a angle were lower compared with the preoperative values, respectively （ P 〈 0.05 ） but the con- sumption of blood products of group C was remarkably lower than that in group V （ P 〈 0.05 ）. CONCLUSION ： Compared with those of the patients with simple cirrhosis, the perioperative eoag- ulative function of patients with liver cirrhosis complicated with HCC is better and blood loss and volume of transfused blood prod- ucts are lower.
出处
《第四军医大学学报》
北大核心
2009年第2期172-174,共3页
Journal of the Fourth Military Medical University
关键词
肝移植
肝硬化
癌
肝细胞
凝血功能
liver transplantation
liver cirrhosis
carcinoma,hepatocellular
coagulative function
