肝移植围手术期出凝血功能的变化

Variations of hemorrhage and coagulation during perioperative period of orthotopic liver transplantation

目的探讨原位肝移植围手术期出凝血功能变化的规律。方法 2000年6月至2009年6月实施34例原位肝移植。对术前、术中开腹后10 min、无肝期30 min和新肝植入后30 min(新肝植入早期),关腹前10 min和术后48 h的血小板、凝血酶原时间(PT)、凝血酶原时间的国际标准化比值(INR)、活化部分凝血活酶时间(APTT)和血浆纤维蛋白原(Fg)进行分析。结果与术前相比,本组受体在无肝期30 min出现血小板明显减少(P<0.05),PT、APTT、INR延长(P<0.05),Fg增加(P<0.05),于新肝植入早期变化最显著。随着新肝植入,在术后48 h时PT、APTT、Fg及INR接近正常范围。结论肝移植术中出凝血功能变化幅度较大,无肝期凝血功能障碍明显,术后凝血功能恢复较快,可接近正常范围。

Objective To investigate the variations of hemorrhage and coagulation during perioperarive period of orthotopic liver transplantation （OLTx）. Methods Thirty-four consecutive OLTx were performed in our hospital from June 2000 to June 2009. The platelet （PLT）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fg） and international normalized ratio （INR） were tested at different time points （preoperation, 10 minutes after operation, 30 minutes of anhepatic phase, 30 minutes after implantation of grafts, 10 minutes before the end of operation and 48 h after operation）. Results Decrease of PLT count, increase of Fg and prolongation of PT, APTT and INR were observed in recipients in anhepatic phase and the early neohepatic phase, which were significantly different compared to the preoperative phase （ all in P 〈 0. 05）. All the variations but PLT were almost back to normal 48 h after OLTx. Conclusion Dysfunction of hemorrhage and coagulation is obvious in anhepatic phase and develops more seriously in the early neohepatic phase. Hemorrhagic and coagulative function recovers quickly in the early postoperative period, which approach to the preoperative phase.