丹参酮ⅡA磺酸钠对肝移植术后肝动脉血栓形成的影响

The clinical research of Tanshinone type ⅡA sulfonate on preventing hepatic artery thrombosis after liver transplantation

目的 探讨丹参酮ⅡA磺酸钠对肝移植术后凝血机制的影响,观察其对肝动脉血栓形成（hepatic artery thrombosis,HAT）的预防作用.方法 将符合入选标准的60例行肝移植手术的患者采用随机数字表法分为2组,每组30例.治疗组于术后血液动力学稳定后静脉滴注丹参酮ⅡA磺酸钠,对照组采用西医常规治疗方案.2组均治疗7 d.采用CA1500血凝仪检测患者凝血功能,采用TEG5000凝血分析仪行血栓弹力图参数（thrombelastography,TEG）分析,采用彩色多普勒超声诊断仪监测肝动脉阻力指数（hepatic artery resistance index,RI）,观察并记录患者并发症及不良反应.结果 治疗组术后TEG反应时间[（6.35±1.59）min比（5.21±1.37）min,t=2.453]较对照组延长、最大振幅[（58.07±5.42）mm比（61.67±5.63）mm,t=-2.532]较对照组下降、RI[（0.73±0.11）比（0.62±0.10）,t=-2.948]高于对照组（P〈0.01）.对照组术后发生出凝血相关并发症2例,治疗组未发生.结论 丹参酮ⅡA磺酸钠可影响肝移植患者术后的凝血功能,预防HAT.

Objective To observe the clnical effects of influence of tanshinone type ⅡA sulfonate on preventing hepatic artery thrombosis after transplantation.Methods A total of 60 patients after liver transplantation were randomly individed into the treatment group and control group, each 30 patients. The treatment group received tanshinone ⅡA sodium sulfonate treatment （60 mg qd, ivgtt continuous 10d） , while the control group used conventional heparinization. The blood coagulation index and the thrombelastograph variables were detected after 7 days and the hepatic artery resistance index （RI） was detected by using Doppler ultrasonography. The postoperative complications and mortality rates were analyzed.Results Although it had little improvement on the coagulation function after liver transplantation, tanshinone ⅡA sodium sulfonate had significant improvement on the time of thrombelastograph parameters reaction （6.35 ± 1.59 minvs. 5.21 ± 1.37 min,t=2.453） and maximum amplitude （58.07 ± 5.42 mmvs. 61.67 ± 5.63 mm,t=-2.532）. It showed that RI have significantly statistical difference between the two groups after treatment （0.73 ± 0.11vs. 0.62 ± 0.10;t=-2.948,P〈0.01）. During the trial, the control group had 2 cases of postoperative complications, HAT and bleeding.Conclusions The Tanshinone ⅡA sodium after liver transplantation can improve the clotting mechanism, preventing HAT.