肝移植出血特点及活化重组人凝血因子VⅡ在移植中的应用(英文)

Hemorrhagic features and the application of recombinant activated factor VⅡ in liver transplantation

背景:如何评估肝移植过程中的出血、止血、凝血功能以及使用怎样的止血措施解决凝血问题,目前还没有常规止血指导方案。目的:探讨肝移植过程中各时间段出血特点并观察活化重组人凝血因子VⅡ在肝移植中的应用效果。设计、时间及地点:回顾性病例分析及对比观察实验,2001-04/2006-07中山大学附属第二医院普通外科完成。对象:2001-04/2003-03接受肝移植患者15例为回顾性研究对象;2003-03/2006-07接受肝移植的28例患者,随机均分为2组:活化重组人凝血因子VⅡ组和对照组。方法:对前期15例肝移植患者出血规律进行回顾性分析并统计各个时间段出血特点。对后期28例患者进行对比观察,活化重组人凝血因子VⅡ组移植前10min静脉推注活化重组人凝血因子VⅡ70～80μg/kg,推注速度为3～5min。对照组同样方式推注50mL的生理盐水。主要观察指标:15例接受肝移植患者各时期的出血量;14例患者使用活化重组人凝血因子VⅡ前及用药后30min的凝血酶原时间、活化的部分凝血活酶时间及血总量。结果:广泛渗血是造成肝移植过程中出血的主要原因,在病肝切除阶段的广泛渗血是主要的出血时间段,活化重组人凝血因子VⅡ可以较好地改善多种凝血功能指标,使血栓弹力图指标r,k,α角度和最大振幅及常规指标凝血酶原和部分凝血活酶时间改善。活化重组人凝血因子VⅡ组较对照组移植过程出血明显减少;活化重组人凝血因子VⅡ组较对照组移植时间明显缩短;活化重组人凝血因子VⅡ组14例在观察期间均未发生血栓并发症。结论:肝移植切肝时间相的广泛渗血为肝移植主要出血时间。活化重组人凝血因子VⅡ可以成功的地应用于肝移植。

BACKGROUND： Hemorrhage, hemostasis, and blood coagulation, as well as the application of hemostasis measures, in the liver transplantation have been poorly understood. There have been no protocols regarding routine hemostasis. OBJECTIVE： To investigate the hemorrhagic features in each phase and to observe the application efficacy of recombinant activated factor Ⅶ （rFⅦ a） during the liver transplantation. DESIGN, TIME AND SETTING： A retrospective case analysis, controlled observation experiment was performed at the Department of Common Surgery, Second Affiliated Hospital of Sun Yat-sen University between April 2001 and July 2006. PARTICIPANTS： Fifteen patients who received liver transplantation between April 2001 and March 2003 served as retrospective study subjects. An additional 28 patients who underwent liver transplantation between March 2003 and July 2006 were randomly and evenly divided into two groups： rFⅦa and control. METHODS： The hemorrhage rule of 15 patients who received liver transplantation in the protophase was retrospectively analyzed and the hemorrhagic feature in each time period was localized. A comparative observation was performed in the 28 patients in the anaphase. The rFⅦ a group received an intravenous injection of 70 80 μ g/kg rFⅦ a for 3-5 minutes. Simultaneously, the control group was given 50 mL physiological saline in parallel. MAIN OUTCOME MEASURES： Hemorrhage volume of 15 patients that received liver transplantation in each phase; prothrombin time, activated partial thromboplastin time, and total hemorrhage volume prior to and 30 minutes after rFⅦ a application in 14 patients who received liver transplantation. RESULTS： Extensive errhysis was a primary cause of hemorrhage in the liver transplantation. Hemorrhage primarily occurred in the phase of diseased liver resection （i.e., pre-anhepatic phase）, rFⅦ a could well improve various coagulation functional indices, i.e., thromboelastography indices （reaction time, coagulation time, a angle, and maximum amplitude） and routine blood indices （prothrombin time and activated partial thromboplastin time）. Compared with the control group, hemorrhage volume was obviously decreased and transplantation time was significantly shorter in the rFⅦ a group. In addition, no thrombotic complications were found in the rFⅦ a group during the observation period. CONCLUSION： The pre-anhepatic phase is a primary hemorrhage phase during the liver transplantation, rFⅦ a can be successfully applied for liver transplantation.