血栓弹力图应用于肝移植患者围手术期凝血功能的评价

Evaluation of thromboelastography in the perioperative blood coagulation of patients with liver transplantation

目的用血栓弹力图(TEG)监测肝移植患者围手术期的凝血功能,探讨其在肝移植患者凝血功能监测及指导应用血制品的临床价值。方法选取武汉大学中南医院2014年12月至2017年1月收治的29例肝移植患者,抽取其在手术前、无肝期、新肝期、关腹及术后3 d时的血液标本,分别进行常规凝血项目、TEG及血小板检测,TEG参数包括反应时间(R)、凝固时间(K)、α角、最大振幅(MA)。根据相应参数的变化来指导应用血制品:R>7 min时输注新鲜冰冻血浆;MA<50 mm时输注血小板;α角<30°时输注Fg,然后在术后评价凝血功能的调控效果。结果经TEG指导用血制品调控凝血功能后,29例患者在无肝期、新肝期、关腹时及术后3 d的TEG参数及常规凝血项目与术前比较差异均无统计学意义(P>0.05),术后也未发生出血或血栓并发症。结论 TEG可以很好地监测肝移植患者围手术期的凝血功能,提供调控依据并指导术中血制品的应用。

Objective To monitor the coagulation function of liver transplantation patients during perioperative period by using thromboelastography（TEG）, and to investigate the clinical value of the coagulation function monitoring and guide the application of blood products. Methods From December 2014 to January 2017, 29 cases with liver transplantation in Zhongnan Hospital of Wuhan University were selected. Blood samples were collected before the operation, during the anhepatic period, neohepatic phase, at the close of the abdomen and 3 days after liver transplantation.Routine coagulation, TEG and platelet were detected and measured, and the TEG parameters included reaction time（R）,clotting time（K）, angle（α）, and maximum amplitude（MA）. The application of blood products was guided according to the changes of the corresponding parameters： fresh frozen plasma was given when R was more than 7 minutes; blood platelet was given when MA was less than 50 mm; Fg was given when α was less than 32°. The effect of coagulation function after operation was evaluated. Results After TEG guidance was used to regulate coagulation function with blood products, there was no significant difference in the TEG parameters and routine coagulation items before the treatment among 29 patients during the anhepatic and neohepatic phase, at the close of the abdomen and 3 d after the operation（P〉0.05）. There was no postoperative bleeding or thrombus complication. Conclusion TEG can well monitor the perioperative coagulation function of liver transplantation patients, and provide the basis and guidance for controlling coagulation function and blood products.