原位肝移植术后监测内、外源性凝血因子和D-二聚体的初步探讨

The Primary Study in Surveillance of Endogenous and Exogenous Coagulation Factors and D-Dimer after Liver Transplantation

目的探讨原位肝移植术后患者内、外源性凝血因子及D-二聚体变化情况,观察术后补充凝血因子后的效果。方法 5例原位肝移植患者手术前后检查PT和APTT,术后第1天抽血分别查内、外源性凝血因子和D-二聚体,第3天复查D-二聚体。结果 5例原位肝移植患者手术前后检查PT和APTT均无显著变化,内源性凝血因子主要有Ⅺ、Ⅻ较正常值降低,外源性凝血因子主要有Ⅱ、Ⅶ、Ⅹ较正常值降低,术后第一天D-二聚体均升高明显,根据结果补充凝血因子后,第三天D-二聚体显著下降,但大部分仍高于正常。结论原位肝移植患者术后存在内源性凝血因子Ⅺ、Ⅻ和外源性凝血因子Ⅱ、Ⅶ、Ⅹ缺乏现象,以外源性凝血因子缺乏的程度最为严重,补充缺乏的凝血因子后第3天D-二聚体明显下降,故移植术后除常规观察PT和APTT外,还应该根据凝血因子测定来补充凝血因子,避免发生医源性凝血功能紊乱,凝血因子的测定可作为原位肝移植术后常规检查中积极而有益的补充。

Objective To explore the change of endogenous and exogenous coagulation factors and D-Dimer after orthotopic liver transplantation(OLT)and outcome after supplementary coagulation factors.Methods The surveillance of PT and APTT in five patients before and after OLT and endogenous and exogenous coagulation factor and D-Dimer the first day after OLT and D-Dimer in the third day after OLT.Results The surveillance of PT and APTT in five patients before and after OLT were no significant difference.The main decrease in endogenous coagulation factors was Ⅺ and Ⅻ.The main decrease in exogenous coagulation factors were Ⅱ、Ⅶ、Ⅹ.D-Dimer in the first day after OLT increased significantly and decreased in the third day markedly,but most of it was still higher than that in normal.Conclusion There are phenomena in deficiency of endogenous and exogenous coagulation factors after OLT and exogenous coagulation factors above all.After supplementary coagulation factors,D-Dimer decreased markedly in the third day.Therefore,besides the surveillance of PT and APTT,it should supplement coagulation factors on account of the surveillance of coagulation factors.The surveillance of coagulation factors should be active and benefic supplementary in routine examination after OLT and need to make further study.