原位肝移植中凝血功能的变化及鱼精蛋白的使用

Abnormal coagulation function during orthotopic liver transplantation and use of protamine

目的:通过对原位肝移植患者凝血功能变化和鱼精蛋白对凝血功能影响的观察,分析新肝早期凝血功能障碍的原因及处理方法。方法:分别在无肝前期1h、无肝期0.5h和新肝期10min取静脉血行TEG分析。TEG分析的R时间(R0)大于肝素酶修正的R时间(R1)5min以上,静脉注射鱼精蛋白25～50mg,10min后取静脉血行TEG分析;若新肝期10min时R0-R1<5min,则在新肝期1h取静脉血行TEG分析。结果:新肝期10min时,70%患者R0较R1明显延长;与肝素酶修正的值比较,R0较R1明显延长患者的K时间明显延长,Angle值明显变小,MA值明显减小;对R0-R1>5min患者静脉注射鱼精蛋白25～50mg后,凝血功能得到纠正。结论:新肝早期大多数肝移植患者存在肝素样活动,导致凝血功能障碍;静脉注射鱼精蛋白可有效逆转此肝素样活动。

Objective： To observe the changes in coagulation function during orthotopic liver transplantation, analyze the eauses of abnormal coagulation function and explore the use of protamine. Methods： Native thrombelastograph （TEG） and hepa- rinase-modified TEG were measured 60min in pre-anhepatic phase, 30min in anhepatic phase, 10min in neohepatic phase, respectively. Protamine 25-50mg was given bv intravenous injection when R time （R0） measured by native TEG in neohepatic phase was 〉5rain than R time （ R1） measured by heparinase modified TEG. Native TEG and heparinase-modified TEG were measured 10min after injection of protamine. When R1 in neohepatic phase was 〈 5min than R1, native TEG and heparinasemodified TEG were measured 60rain in neohepatic phase and no protamine was given. Results： At 10min in neohepatic phase, R0 was significantly prolonged than Rt in 70% of patients. Furthermore, their K value was significantly higher, angle value became lower and MA value decreased. After injection of 25-50mg protamine, the changes in coagulation function became normal. Conclusion： Most orthotopic liver transplantation patients have coagulation abnormalities caused by heparin activity in early neohepatic phase. Intravenous injection of protamine can reverse the effect of heparin and heparin-like substances on coagulation function.