亲体肝移植患者围手术期止血与凝血指标的变化

Hemostatic and coagulative variations of patients at perioperative period following living related liver transplantation

背景:亲体供肝移植后由于止血和凝血指标的异常可出现出血及血栓等严重并发症,但其具体变化规律如何尚未见报道。目的:探讨亲体肝移植受体围手术期止血与凝血指标的变化。方法:抽取44例亲体肝移植受者移植前、移植后1～7d静脉血,检测患者血浆中活化部分凝血活酶时间、凝血酶原时间、凝血酶时间、纤维蛋白原含量、血小板、抗凝血酶活性、纤溶酶原活性、纤溶酶原激活物抑制剂1活性、D-二聚体、纤维蛋白降解产物的动态变化。以32名体检中心健康体检者为对照。结果与结论:移植前活化部分凝血活酶时间、凝血酶原时间、凝血酶时间延长(P<0.01),纤维蛋白原含量、血小板、抗凝血酶活性、纤溶酶原活性降低(P<0.01),纤溶酶原激活物抑制剂1升高(P<0.01);移植后1周凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、血小板、纤维蛋白原含量、抗凝血酶活性逐渐恢复正常,纤溶酶原活性、纤溶酶原激活物抑制剂1、D-二聚体、纤维蛋白降解产物仍异常于正常值(P<0.01)。结果提示亲体肝移植后凝血因子、抗凝因子的恢复是相对较快的,而纤溶因子的恢复则较为迟缓,纤溶功能亢进,是肝脏移植严重出血的主要原因,因此在移植后凝血与止血功能的监测,是预防出血和血栓形成的有效措施。

BACKGROUND： The abnormality of hemostatic and coagulative indexes can result in serious complications, such as hemorrhage and thrombus, for patients following living related liver transplantation, however, the detail change laws remain poorly understood. OBJECTIVE： To study the hemostatic and coagulative variations at perioperative period following living related liver transplantation. METHODS： The venous blood were collected from 44 patients prior to and 1-7 days after living related liver transplantation. The dynamic changes of partial thromboplastin time （APTT）, prothrombin time （PT）, thrombin time （TT）, fibrinogen contents, platelet, antithrombin activity, plasminonen activity, plasminogen activator inhibitor activity 1 （PAI-1）, D-dimer, and fibrin degradation product were examined. Simultaneously, 32 healthy people were served as controls. RESULT AND CONCLUSION： A prolongation of APTT, TT and PT were observed in patients prior to transplantation （P 0.01）. The platelet count, antithrombin activity, and plasminonen activity were reduced （P 0.01）, but the PAI- 1 was increased （P 0.01）. The PT, APTT, TT, platelet count, antithrombin activity, and antithrombin activity were recovered to normal level at 1 week after transplantation, but the levels of plasminonen activity, PAI-1, D-dimer, and fibrin degradation product were still abnormal. The results revealed that the coagulant and anticoagulant functions could be normal by successful operation and the recovery of fibrinolvtic functions were delayed, which are the main reasons for severe hemorrhage. Thus, the monitoring of coagulation and hemostatic function play an effective role in preventing hemorrhage and thrombosis.