血栓弹力图评估肝移植患者围术期凝血状态

Evaluation of Coagulation Function in Perioperative Liver Transplantation Patients Using Thrombelastography

目的 采用新的凝血功能检测方法结合传统凝血指标,评估肝移植患者凝血功能并指导围术期输血。方法 利用血栓弹力图结合常规凝血指标,评估肝移植患者术前凝血状态。将血栓弹力图各指标与常规凝血指标进行相关性分析。对肝移植患者术前病情严重程度进行Child-Pugh分级,比较不同肝功能损伤患者术前凝血功能的差异。结果 常规凝血指标示肝移植患者术前血小板明显降低、凝血因子严重不足;血栓弹力图示除了MA值略有异常,余均在正常范围。相关性分析显示除R时间与活化的部分凝血活酶时间无相关性,血栓弹力图其他指标与其对应的常规凝血指标均有一定的相关性。术前重度肝功不全的患者更趋于低凝状态。结论 肝移植患者术前处于轻度低凝状态,肝功能障碍越重的患者低凝状态越严重,可根据实时的血栓弹力图指标指导围术期输血。

Objective To evaluate coagulation function in liver transplantation patients and guide perioperative blood transfusion using a new coagulation assay combined with conventional coagulation assays.Methods Thrombelastography(TEG)and conventional coagulation assays were used to evaluate preoperative coagulation status in liver transplantation patients.Correlation analysis between TEG and conventional coagulation assays was performed.Liver transplantation patients were classified into two groups according to Child-Pugh grading to assess differences in preoperative coagulation status.Results TEG results suggested that all indexes were within normal range,except for maximum amplitude,whereas conventional coagulation assays suggested that thrombocytopenia was present and coagulation factors were severely deficient.There was no correlation between reaction time and activated partial thromboplastin time,and other TEG indexes were correlated with conventional coagulation assays.Patients with severe liver dysfunction tended to be more severely hypocoagulable.Conclusion Preoperative liver transplantation patients tend to be slightly hypocoagulable.Patients with severe liver dysfunction tend to be more severely hypocoagulable.Perioperative transfusion can be guided more appropriately according to real-time TEG results.