原位肝移植止血和凝血功能变化的研究

Study on hemostatic and coagulative variations during orthotopic liver transplantation

目的 探讨原位肝移植止血和凝血功能的变化。方法 测定肝移植术前、术中血小板、凝血、抗凝及纤溶系统系列指标 ,观察其变化规律。结果 术中活化部分凝血活酶时间 (APTT)、凝血酶原时间 (PT)、凝血酶时间 (TT)延长 ,血小板计数 (PLT)、多数凝血因子活性降低、抗凝血酶(AT)、纤溶酶原 (PLG)、纤溶酶原激活物抑制剂 1 (PAI 1 )、α2 抗纤溶酶 (α2 AP)水平降低 ,组织型纤溶酶原激活物 (t PA)、纤溶酶 α2抗纤溶酶复合物 (PAP)、凝血酶 抗凝血酶复合物 (TAT)水平升高。与术前相比 ,新肝期各种改变更显著。结论 整个原位肝移植手术过程中 ,凝血与抗凝功能减低 ,无肝期与新肝期纤溶功能亢进。

Objective To investigate the hemostatic and coagulative variations during orthotopic liver transplantation (OLT).Method The blood platelet count, coagulant and anti-coagulant functions were assessed pre- and intra-operation of OLT.Results During the operation, activated partial thromboplastin time (aPTT) and prothrombin time (PT) were prolonged, platelet count (PLT), activities of most of the coagulation factors and levels of antithrombin (AT), plasminogen (PLG), plasminogen activator inhibitor-1 (PAI-1) and α2 -antiplasmin (α2-AP) were reduced, while the levels of tissue plasminogen activator (t-PA), plasmin-α2-antiplasmin complex (PAP) and thrombin-antithrombin complex (TAT) were increased. The variations in the neohepatic phase were more significant than that in the pre-operation phase. Conclusion In the entire process of OLT operation, the coagulant and anti-coagulant functions were decreased, and the fibrinolytic functions were sthenic in the anhepatic phase and the neohepatic phase.