凝血弹性图在活体肝移植术中应用的研究

Investigation of thromboelastography in the peri-operative period of living donor liver transplantation

目的对成人活体肝移植术中使用凝血弹性图进行凝血功能监测,探讨手术各阶段凝血紊乱的诱因及相应治疗方法。方法 33例行活体肝移植手术患者,于手术开始时(T_1)、无肝期再灌注前5min(T_2)、新肝期再灌注后5min(T_3)及再灌注后60min(T_4)进行肝素酶修正及自然全血凝血弹性图检测。结果 T_1及T_2肝素酶修正组与自然全血组凝血弹性图数值差异无统计学意义(P>0.05)。T_3时自然全血组与肝素酶修正组数据均显示低凝状态且肝素或肝素样物质为主要原因。T_4后肝素造成的凝血异常逐步改善,但较之T_1仍处于低凝状态。结论凝血弹性图对凝血状况的连续监测可以快速准确判断活体肝移植术中不同阶段凝血异常的原因,指导临床针对性治疗,并可评价治疗效果。

Objective To monitor the efficiency of coagulation in the blood using peri-operative thromboelastography, to investigate the causes of coagulopathy and find out the best treatment methods in patients with living donor liver transplantation. Methods Data were collected from 33 patients with living donor liver transplantation.The coagulation profile was evaluated by heparanase modified TEG（HTEG） and the native TEG（NTEG） at the beginning of surgery（T_1）,5 min before reperfusion（T_2）,5 min after reperfusion（T_3）,60 min after reperfusion（T_4）.Results There was no significant difference between HTEG and NTEG at T_1 and T_2 time points（P0.05）.HTEG and NTEG show hypocoagulation at T_3 time point due to heparin and heparin-like substances.The coagulopathy was improved at T_4 time point,but still show hypocoagulation compare with T_1.Conclusion The thromboelastography monitoring could determine the reasons of coagulapathy in adults with living donor liver transplantation,and it is also helpful for guiding blood component therapies and pharmacological interventions.