肝门阻断再开放对肝部分切除术患者凝血功能和动脉血气的影响

Effects of hepatic portal occlusion-release on blood coagulation and arterial blood gas in patients with partial hepatectomy

目的探讨肝门阻断再开放对肝部分切除术患者凝血功能和动脉血气的影响。方法择期全身麻醉下行肝部分切除术患者18例,术中采用Pringle法行肝门阻断(16.6±7.7)min。分别于手术开始后10min(T1)和肝门阻断开放后3min(T2)行动脉血气分析,并应用血栓弹力图描记仪(TEG)检测凝血功能。结果与T1比较,T2时TEG各指标反应时间(R值)、凝固时间(K值)、凝固角(α角)、血栓最大幅度(MA值)、血栓溶解指数(LY30)值和凝血指数(CI)的差异均无统计学意义(P>0.05);与T1比较,T2时乳酸明显升高,pH值明显降低,碱剩余值(BE)和二氧化碳分压(HCO3-)值明显减小(P<0.01)。结论短时间肝门阻断对患者的凝血功能没有显著影响,但可使机体内酸性物质堆积。

Objective To investigate the effects of hepatic portal occlusion-release on blood coagulation and arterial blood gas in patients undergoing partial hepatectomy.Methods Eighteen patients scheduled for partial hepatectomy under general anesthesia were studied.Total hepatic portal blood vessels was clamped with Pringle method for（16.6±7.7） minutes.Arterial blood gas analysis and thrombelastography（TEG） were performed at 10 minutes after surgical incision（T1） and 3 minutes after hepatic portal reperfusion（T2）.Results There were no obvious differences in the values of R,K,MA,and LY30,α angele,and CI on TEG between T1 and T2（P0.05）.Plasma lactic acid at T2 was significantly higher than that at T1（P0.01）.The values of pH,BE and HCO-3 at T2 were significantly lower than those at T1（P0.01）.Conclusion Hepatic portal occlusion for a short period of time does not impact coagulation function,but may increase blood acidic substances.