原位肝移植术中液体的管理

Fluid management in orthotopic liver transplantation

目的分析影响原位肝移植术中补液的因素。方法96例肝移植患者根据其术前肝功能不同分为晚期肝硬化组(ChildC级,50例)和非晚期肝硬化组(ChildA级或B级,46例);非晚期肝硬化组根据术中出血量又分为A亚组(出血<2000ml)和B亚组(出血≥2000ml)。监测手术前后血浆白蛋白与凝血功能变化,记录术中出血及输入血液制品情况。结果晚期肝硬化组术前血浆凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)均显著长于非晚期肝硬化组(P均<0.05);血小板和纤维蛋白原均显著低于非晚期肝硬化组(P均<0.05),术毕两组各指标差异均无显著性(P均>0.05)。非晚期肝硬化组中A亚组术中输入各种血液制品量显著低于晚期肝硬化组(P均<0.05);B亚组术中输入各种血液制品量与晚期肝硬化组比较差异均无显著性(P均>0.05)。结论肝移植术中,肝硬化晚期或出血量大的患者需要补充更多的血液制品。

Objective To investigate the influential factors of fluid management during orthotopic liver transplantation surgery. Methods Ninety-six patients scheduled for orthotopic liver transplantation were divided into two groups according to the liver function ： the decompensatory group （Child-Pugh score C, n=50） and the compensatory group （Child-Pugh score A or B, n=46）. According to the intraoperative bleeding amount, the compensatory group was further divided into subgroup A （〈2 000 ml） and subgroup B （≥2 000 ml）. Plasma albumin concentration and the parameters of blood coagulation were measured before and after the surgery. The intraoperative bleeding amount and the amount of the blood products infused were recorded. Results Before the surgery, prothrombin time （PT） and activated partial thromboplastin time （APTT） were significantly longer in decompensatory group than in compensatory group （both P〈0.05）; blood platelets （PLT） and fibrinogen were significantly lower in decompensatory group than in compensatory group （both P〈0.05）. After the surgery, there were no significant differences in PT, APTT, PLT, and fibrinogen between the two groups （all P〉0. 05 ）. The amounts of the blood products infused intraoperatively in subgroup A were significantly lower than those in the decompensatory group （all P〈0.05）. There was no significant difference in the amount of the infused blood products between the subgroup B and decompensatory group （all P〉0.05）. Conclusion During orthotopic liver transplantation surgery, patients with decompensatory liver function, or those who suffered large amounts of intraoperative bleeding, need infusion of lareer amount of blood products.