静脉输注中等剂量氨甲环酸和乌司他丁对原位肝移植术患者纤溶功能的影响

Effects of continuous infusion of moderate dose tranexamic acid and ulinastatin on fibrinolysis during orthotopic liver transplantation

目的评价静脉输注中等剂量氨甲环酸和乌司他丁对原位肝移植术患者纤溶功能的影响。方法拟行原位肝移植术患者30例，性别不限，年龄34—63岁，体重指数17—37kg／m2，终末期肝病模型评分6～34分，ASA分级Ⅲ或Ⅳ级。采用随机数字表法，将患者随机分为3组（n=10）：对照组（C组）、氨甲环酸组（T组）和乌司他丁组（U组）。U组和C组气管插管后分别静脉输注乌司他丁100000U／h或生理盐水10ml／h直至新肝期120min；T组气管插管后静脉注射氨甲环酸负荷量1g，随后以10mg·kg^-1·h^-1速率静脉输注至新肝期120min。分别于麻醉诱导前（T0）、无肝前期120min（T1）、无肝期30min（T1）、新肝期30min（B）、新肝期120min（T4）和术毕（L）时采集静脉血样，测定凝血酶原时间（PT）、活化部分凝血酶原时间（A肿）、国际标准化比值（INR）、纤维蛋白原（Fg）、D-二聚体（D-D）和纤维蛋白降解产物（FDP）的水平。记录术中出血量及输血情况。记录术后14d内T组和u组肝动脉或门静脉血栓形成情况。结果3组间血浆PT、APTF、Fg、INR、出血量和输血量差异无统计学意义（P〉0．05）。与C组比较，T组T3-5时血浆D-D浓度降低，T4，时血浆FDP〉20μg／m1比率降低（P〈0．05或0．01），u组血浆D．D浓度和血浆FDP〉20μg／ml比率差异无统计学意义（P〉0．05）。T组和u组未见肝动脉或门静脉血栓形成。结论术中静脉输注中等剂量氨甲环酸可抑制原位肝移植术患者纤溶功能，但不足以减少出血量；术中静脉输注乌司他丁100000U／h对原位肝移植术患者纤溶功能无影响。

Objective To investigate the effects of continuous infusion of moderate dose tranexamic acid and ulinastatin on fibrinolysis during orthotopic liver transplantation （OLT）. Methods Thirty ASA Ⅲ or Ⅳ patients aged 34-63 yr with a body mass index of 17-37 kg/m2 and end-stage liver disease score 6-34, undergoing OLT, were randomly assigned to one of 3 groups （n = 10 each） ： group control （group C） ; group tranexamic acid （group T） and group ulinastatin （group U）. The patients received continuous infusion of normal saline at 10 ml/h in group C or ulinastatin at 100 000 U/h in group U immediately after tracheal intubation until 120 min after portal vein was declamped, while in group T the patients received a loading dose of tranexamic acid 1 g followed by continuous infusion at 10 mg·kg^-1·h^-1. Prothrombin time （PT）, activated partial thromboplastin time （AVIT）, international normalized ratio （INR）, fibfinogen （Fg）, D-dimers （D-D） and fibrin degradation product （FDP） were measured before induction of anesthesia （baseline）, at 120 min after skin incision, 30 rain after clamping of portal vein （anhepatic phase）, 30 and 120 rain after declamping （neohepatic phase） and at the end of operation. The amount of blood loss and transfusion were recorded. The patients were followed up after operation for hepatic artery and portal vein thrombosis in groups U and T. Results There were no significant differences in PT, AVIT, Fg,INR and amount of blood loss and transfusion among the 3 groups. The plasma D-D concentration and percentage of patients with plasma FDP 〉 20 μg/ml were significantly lower in group T than in group C. There were no significant differences in plasma D-D concentration and percentage of patients with plasma FDP 〉 20μg/ml between groups U and C. No hepatic artery and portal vein thrombosis was detected after Operation in groups T and U. Conehtsion Continuous infusion of moderate dose tranexamic acid can inhibit fibrinolysis during OLT, but can not reduce the amount of blood loss. Continuous infusion of ulinastatin （ 100 000 U/h） has no significant effect on fibrinolysis during, OLT.