肝移植术患者术前应用重组活化人凝血因子Ⅶa的效果

Effects of recombinant factorⅦa on blood coagulation in patients undergoing liver transplantation

目的评价肝移植术患者术前应用重组活化人凝血因子Ⅶa(rFⅦa)的效果。方法择期行原位肝移植术的终末期肝病患者20例,ASAⅡ或Ⅲ级,Child-Pugh分级B或C级,术前均存在凝血功能障碍,凝血酶原时间(PT)>20s。切皮前5min静脉注射rFⅦa40-80μg·kg-1。分别于注药前即刻(T0)、注药后5(T1)、15(T2)、30(T3)、60(T4)、120min(T5)、无肝期15min(T6)及新肝期30min(T7)取颈内静脉血4.5ml,测定PT、凝血酶原活度(PTA)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、国际标准化比值(INR)、纤维蛋白原(Fib)、D-二聚体(DD)、血小板计数(PLT)。结果与T0比较,PT和INR在T1-6降低,PTA在T1-6增加,APTT在T2-5缩短,TT在T7延长(P<0．05),各时间点Fib、PLT、DD差异无统计学意义(P>0.05)。术中输注浓缩红细胞(11±6)U,出血总量600-4000ml,其中使用rFⅦa后120min内出血量200-2400ml。给药期间未发生过敏反应,术后未发生静脉血栓等并发症。结论肝移植术前应用rFⅦa可改善患者术中凝血功能,且无明显副作用。

Objective To evaluate the effects of recombinant factor Ⅶa （rFⅦa） on blood coagulation in patients undergoing liver transplantation. Methods Twenty ASA II or m patients with end-stage liver disease （ 17 male, 3 female） aged 27-65 yr weighing 53-120 kg undergoing liver transplantation were enrolled in this study. Their liver function was classified as Child-Pugh score B or C. Their preoperative prothrombin time （PT） was 〉 20 seconds and Hb 51-114 g·L^-1 . rFⅦa 40-80 μg·kg^-1 was given IV as a bolus 5 min before skin incision. Blood samples were taken from internal jugular vein before IV injection of rFⅦa （T0 ,baseline）, at 5, 15, 30, 60 and 120 min after rFⅦa injection （T1-5）, 15 min of anhepatic phase （TO） and 30 min of neohepatic phase （T7 ） for determination of PT, prothrombin activity （PTA）, activated partial thromboplastin time （APTT）, thrombin time （TT）, international normalized ratio （INR）, fibrinogen （Fib）, D-dimer and platelet count （PLTs）.Results PT and INR were significantly reduced at T1-6 compared to the baseline at T0 （ P 〈 0.05 ）. APTr was significantly decreased at T2-5 and Tr was significantly increased at T7 . There was no significant change in Fib, D-dimer and PLTs during operation as compared with baseline. Conclusion It is possible to reduce intraoperative blood loss and transfusion by IV rFⅦa administration which can correct coagulation abnormality to some extent in patients undergoing liver transplantation.