原位肝移植围手术期凝血功能分析95例

Coagulation function analysis in perioperative stage of orthotopic liver transplantation: an analysis of 95 cases

目的:探讨原位肝移植围手术期凝血功能的变化规律以及各凝血指标对于原位肝移植围手术期凝血功能测定的敏感性.方法:2004-01/2006-11于我院行同种异体肝移植术患者95例.分别测定肝移植术前、术中(无肝前期、无肝期及新肝期)及术后24、72h的凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(Fib)、血小板计数(PLT),并描记Sonoclot曲线.用SPSS10.0进行自身配对样本T检验统计学分析.结果:随肝移植手术进行,凝血功能逐渐恶化:PT、APTT逐渐延长,PLT、Fib逐渐减少.至新肝期逐渐达到高峰,以后除PLT外均逐渐好转,术后72h基本恢复至术前水平.Sonoclot曲线体现:激活全血凝固时间(ACT)逐渐延长,凝结速率(CR)逐渐下降,新肝期为最显著,之后逐渐好转.围手术期血小板功能(PF)无明显差异(P>0.05).结论:Sonoclot凝血及血小板功能分析仪的应用对于肝移植术中凝血功能变化的监测及对症处理具有非常重要的作用.

AIM： To investigate variation regulations and sensitivity of coagulation function in perioperative orthotopic liver transplantation. METHODS： Coagulation items of 95 liver recipi- ents who had accepted orthotopic liver transplantation from January 2004 to November 2006 were collected before, during and after the operations and Sonoclot curve was described. All data were analyzed using SPSS10.0. RESULTS： Coagulation function exacerbated with the progression of operation, APTT was prolonged, PLT and Fib were decreased and rebound peak in the new-liver stage. All items except PPT were restored to normal levels within 72 h after operation. The Sonoclot curve showed prolonged ACT, reduced CR, especially in newliver stage, and then all items were recovered to normal levels. There was no significant difference of PF in progression （P 〉 0.005）.CONCLUSION： Sonoclot analyzer plays an important role in coagulation function monitoring during orthotopic liver transplantation.