原位肝移植术中TEG监测下不同时期凝血功能的改变及相应对策

The changes of coagulation function and corresponding countermeasures in different periods of TEG monitoring in orthotopic liver transplantation

目的分析原位肝移植术中TEG监测下不同时期凝血异常的原因并总结相对应的处理。方法同种异体原位肝移植患者21例,术中分别在麻醉诱导后30min(无肝前期)、肝上、下腔静脉、门静脉阻断后10min(无肝期)和肝上、下腔静脉、门静脉开放后10min(新肝期)、关腹时4个时期,抽取静脉血监测血常规,抽取动脉血监测TEG、ACT的各指标。术中根据监测结果,给予成分输血及相关凝药物。结果与无肝前期相比,TEG各指标及ACT值均延长,变化在新肝期最为显著,达到最大值,除MA值外,各时期差异均具有统计学意义(P<0.05)。结论在TEG监测下,肝移植不同时期,凝血状态差别较大,新肝期异常最为显著,因此,不同时期凝血调整也不尽相同,但总体以补充凝血因子及消除体内外肝素影响这两点为主。

Objective To analyze the causes of coagulation abnormality in different periods under monitoring of TEG during orthotopic liver transplantation,and to summarize the corresponding treatments.Methods 21 patients with allograft orthotopic liver transplantation were studied.During the procedure,venous blood was collected for blood routine monitoring and arterial blood for TEG/ACT monitoring at the following four stages:30 min after anesthesia induction(pre-anhepatic stage),10 min after occlusion of suprahepatic vein,inferior vena cava and portal vein(anhepatic stage),10 min after opening of suprahepatic vein,inferior vena cava and portal vein(neohepatic stage)and the moment of abdominal closure.Component blood transfusion and related coagulation drugs were given according to the monitoring results.Results Compared with pre-anhepatic stage,TEG indexes and ACT value were both extended,and changes were most significant at the neohepatic stage.Differences in each stage were statistically significant apart from MA value(P<0.05).Conclusion The differences of coagulation state were significant during different stages of liver transplantation under the monitoring of TEG,and the abnormality during neohepatic stage was most significant.As a result,clotting adjustments also vary in different periods,but overall focus on supplement of clotting factors and elimination of heparin effect both in vivo and in vitro.