乌司他丁对肝移植术输血量和新肝再灌注后纤溶活性的影响

Effects of ulinastatin on voulme of blood infusion and fibrolysis in neohepatic phase in liver transplantation

目的研究肝移植术中使用乌司他丁对改善凝血功能和抑制新肝再灌注后纤溶亢进的作用。方法将40例拟行肝移植手术的患者随机分为乌司他丁组(试验组,n=20)和安慰剂组(对照组,n=20)。于麻醉诱导、无肝期(门静脉阻断10 min)、门静脉开放5 min和60 min以及手术结束时分别测定血小板、凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)和纤维蛋白原(Fg);血栓弹力图(TEG)监测,记录凝血指数(CI)值;记录术中失血量和红细胞、新鲜冰冻血浆和冷沉淀输注量。结果门静脉开放5 min后,试验组中CI<0.8的例数明显少于对照组(4vs14)(P<0.05);试验组患者的失血量、红细胞输注量和新鲜冰冻血浆输注量均明显少于对照组。结论乌司他丁能抑制新肝再灌注后的纤溶系统亢进活性,并能减少术中出血和输血。

Objective To investigate the roles of ulinastatin in improving coagulation function and inhibiting fibrolysis in neohepatic phase in liver transplantation. Methods Forty patients who were to undergo liver transplantation were randomly divided into ulinastatin group （experiment group, n = 20） and placebo group （control group, n = 20）. Platelet, prothrombin time （PT）, activated partial thromboplastin time （APTT） and fibrinogen （Fg） were measured at induction, anhepatic phase （10 min after clamping）, neohepatic phase （5 and 60 min after unclamping） and the end of operation. Coagulation index （CI） of thromboelastogram （TEG） was monitored, and the volumes of blood loss, red blood cells infusion, fresh frozen plasma infusion and cryoprecipitate infusion were recorded. Results Five min after unclamping, the number of patients with CI 〈0.8 in the experiment group was significantly less than that in the control group （4 vs 14, P 〈0.05）. The volumes of blood loss, red blood cells infusion and fresh frozen plasma infusion in the experiment group were less than those in the control group. Conclusion Ulinastatin can inhibit the fibrolysis during neohepatic phase and decrease the volumes of blood loss and blood infusion in liver transplantation.