供肝保养液中不同浓度肝素对肝移植术患者新肝期凝血功能的影响

Effects of different concentrations of heparin in the preservation solution on blood coagulation after reperfnsion in patients undergoing orthotopic liver transplantation

目的探讨供肝保养液中不同浓度肝素对肝移植术患者新肝期凝血功能的影响。方法拟行肝移植术的终末期肝病患者40例,随机分为3组,供肝保养液中肝素浓度分别为2 000 U/L(Ⅰ组,n=14)、8 000 U/L(Ⅱ组,n=12)、20 000 U/L(Ⅲ组,n=14)。新肝期前15 min(T0)、新肝期5、30、60、 120、180 min(T1、T2、T3、T4、T5)采中心静脉血,行Sonoclot凝血和血小板功能分析,各组随机测定3-4 例患者血浆肝素浓度(高效液相色谱法)。结果与T0相比,Ⅲ组T1-4时玻璃珠激活凝血时间 (gbACT)均延长,T1-3时血块凝结速率(CR)减慢,T1,2时血小板功能(PF)减小,Ⅱ组T1,2时gbACT延长,T1时CR减慢(P<0．05或0．01),Ⅲ组上述指标的变化较Ⅱ组明显;T1,2时Ⅲ组血浆肝素浓度高于Ⅱ组(P<0．05),Ⅰ组新肝期各时点均未检测到肝素。结论保养液中高浓度肝素可抑制肝移植术患者新肝期凝血功能。

Objective To investigate the effect of different concentrations of heparin in the cold preservation solution on blood coagulation after reperfusion during orthotopic liver transplantation （OLT） . Methods Forty ASA Ⅱ or Ⅲ patients with end-stage liver disease （31 males, 9 females） weighing 51-82 kg undergoing OLT were randomly divided into 3 groups according to the concentrations of heparin in the liver preservation solution： groupⅠ 2000 U·L^-1（n=14）; groupⅡ 8000 U·L^-1（n=12） and group Ⅲ 20000 U· L^-1（n= 12）. Anesthesia was induced with propofol, fentanyl and rocuronium and maintained with isoflurane inhalation and intermittent i.v. boluses of fentanyl. Body temperature was maintained at 35.5-37.5℃ and Hct at 22%-35%. Blood samples were taken from central vein at 15 min before reperfusion （To ,baseline） and 5, 30, 60, 120 and 180 min of reperfusion （T1-5 ） for determination of ACT, CR and platelet function （PF） using Sonoclot platelet function and coagulation analyzer （ U. S. A. ） . Blood concentration of heparin was determined in 3-4 patients in each group at T0-5 （HPLC） . Results The 3 groups were comparable with respect to age, body weight, ASA physical status and Child classification. The glass ball activated coagulation time （gbACT） was significantly prolonged at T1-4 in group Ⅲ and at T1-2 in group Ⅱ as compared to the baseline values at To （ P 〈 0.05 or 0.01 ）. There was no significant difference in gbACT before and after reperfusion in group Ⅰ . In group Ⅲ the rate of clot formation （CR） at T1-3 and PF at T1,2 were significantly decreased as compared to the baseline values at To （ p 〈 0.01 or 0.05）. The plasma concentration of heparin at T1,2 was significantly higher in group Ⅲ than in group Ⅱ . No heparin was detected in plasma during reperfusion in group Ⅰ . Conclusion High concentration of heparin in the liver preservation solution significantly affect blood coagulation during reperfusion in OLT.