摘要
目的探讨肝移植手术病人围术期凝血功能的变化。方法对我院2014年3—12月实施肝移植手术病人50例进行研究,病人肝功能Child-Pugh评分为C级。分别于术前、无肝前期、无肝期30min、新肝期30min和术毕从中心静脉采血,进行血常规、钙离子(Ca2+)、凝血指标及血栓弹力图(TEG)测定。结果与术前相比,无肝前期、无肝期、新肝期及术毕时病人血红蛋白、血细胞比容显著下降(F=14.40、14.04,P<0.01),无肝期、新肝期及术毕时血小板显著下降(F=5.32,P<0.05)。与术前相比,Ca2+水平在无肝期显著降低,在新肝期、术毕显著升高(F=6.53,P<0.01)。与术前相比,活化部分凝血活酶时间、凝血酶原时间、国际标准化比值在各时间点均显著下降(F=12.34~22.60,P<0.01);纤维蛋白原、抗凝血酶Ⅲ从无肝前期开始下降,在新肝期下降最明显,在术毕略有回升,与术前相比,二者在各时间点下降均有统计学意义(F=30.74、10.20,P<0.01)。与术前相比,随着手术时间的延长,TEG测定反应时间、凝固时间、血凝块形成速率及最大振幅改变在新肝期、术毕有统计学意义(F=21.70~146.81,P<0.01)。结论肝移植手术病人凝血功能波动幅度较大,多数指标在新肝期变化最大,应采用多种方法监测凝血功能,综合判断。
Objective To investigate perioperative changes of blood clotting function in patients undergoing liver transplantation. Methods This study was carried out in 50 patients who underwent liver transplantation(LT)during March-December of 2014.Their liver function was classied into Child-Pugh score class C.Blood samples were collected from central veins-before surgery,pre-anhepatic period,anhepatic period(30min),neo-hepatic period(30min)and at the end of surgery-for blood routine examination,measuring blood calcium(Ca^(2+)),blood coagulation markers and thromboelastogram(TEG). ResultsCompared with before surgery,the changes of the related parameters after surgery were as follows:haemoglobin and hematocrit levels during pre-anhepatic period,anhepatic period,neo-hepatic period and at the end of surgery significantly declined(F=14.40,14.04;P〈0.01),and the platelet count decreased during anhepatic period,neohepatic period and at the end of operation(F=5.32,P〈0.05);Ca2+was significantly declined during anhepatic period,and markedly elevated during neohepatic period and at the end of operation(F=6.53,P〈0.01);the activated partial thromboplastin time,prothrombin time,and international normalized ratio(INR)at each time point were all declined(F=12.34-22.60,P〈0.01);the levels of fibrinogen and antithrombinⅢstarted to lower during pre-anhepatic period and reached its most during neohepatic period,and then upswing a little at the end of surgery(F=30.74,10.20;P〈0.01);with the extension of operating time,the changes of TEG-measured reaction time,coagulation time,velocity of formation of blood clots and maximum amplitude were significant during neohepatic period and at the end of operation(F=21.70-146.81,P〈0.01). Conclusion Large fluctuation of blood clotting function was observed in this study in surgery for liver transplantation,the biggest changes of most markers being noted during neohepatic period.Various methods should be adopted for monitoring blood clot
出处
《青岛大学医学院学报》
CAS
2016年第4期402-405,共4页
Acta Academiae Medicinae Qingdao Universitatis
关键词
肝移植
手术期间
血液凝固试验
血栓弹力描记术
liver transplantation
intraoperative period
blood voagulation tests
thrombelastography