肝移植患者术中用血及相关指标综合分析

Analysis of Intraoperative Blood Transfusion and Related Indexes in Liver Transplantation Patients

目的分析肝移植患者围手术期血液制剂的使用情况和相关指标,以期获得最好的肝移植术中血液保障方案。方法回顾性分析2020年我院因各种肝脏疾病行肝移植手术患者的临床资料,根据其术中是否输注血液制剂分为输血组(n=153)与非输血组(n=30),比较两组患者相关指标;根据其术前诊断将肝移植患者分为肝硬化、肝衰竭、肝癌及其他肝脏疾病组,观察肝移植患者术中出血量、手术时间、各类血液制剂输注量(悬浮红细胞、新鲜冰冻血浆、冰冻血浆、冷沉淀凝血因子);分析肝移植手术前后PT、APTT、FIB、INR值。结果比较输血组和非输血组的检验指标发现,输血组患者的AST、TBIL、Cr、INR和术中出血量高于非输血组(P<0.05),但输血组患者的Hb低于非输血组(P<0.05),两组之间其他指标差异无统计学意义(P>0.05);肝衰竭患者组出血量和手术时间均显著高于其他诊断组(P<0.05),且肝衰竭患者输血率、血液制剂输注量以及不良预后率均高于其他组(P<0.05);各疾病诊断分组患者的术前PT、APTT、FIB、INR数值差异明显(P<0.05),且肝衰竭组术前PT、APTT、FIB数值高于其他组别(P<0.05)。结论围术期PT和APTT等实验室指标对肝移植患者术中备血具有指导作用,且血液制剂的输注率可影响肝移植患者的预后与转归,输血科应针对肝移植术患者术前不同的基础疾病及不同的血液检测指标制定不同的输血策略。

Objective Analysis of the effect of relevant indexes on blood transfusion of liver transplantation patients.Methods To retrospectively analyze the clinical data of patients undergoing liver transplantation due to various liver diseases in our hospital in 2020,the patients were divided into blood transfusion group(n=153)and non-transfusion group(n=30)according to whether they were transfused with blood products during the operation.According to the diagnostic criteria,these patients were divided into liver cirrhosis group,liver failure group,liver cancer group and other liver diseases group.Intraoperative blood loss,operative time and infusion volume of various blood products(red blood cells,fresh frozen plasma,frozen plasma,cryoprecipitate coagulation factor)of liver transplantation patients were observed.Then,the analysis of preoperative and postoperative coagulation indexes including PT,APTT,INR,FIB in the 153 patients received blood transfusion was performed.Results Compared with the no transfusion group,serum AST,TBIL,Cr,INR and intraoperative blood loss of patients in transfusion group were higher(P<0.05),but the hemoglobin levels was lower(P<0.05).There were no significant differences in other indexes(P>0.05).The intraoperative blood loss and operative time of patients were significantly higher in liver failure group than in the other groups(P<0.05),as were infusion volume of various blood preparations and the rate of poor prognosis(P<0.05).Compared with other groups,the preoperative coagulation indexes including PT,APTT,INR,FIB of patients in liver failure group were significantly higher(P<0.05).Conclusion Perioperative PT and APTT have a guiding role in the blood transfusion of liver transplantation,and the transfusion rate can affect the prognosis and outcome of the patients.It is necessary to make different blood transfusion plans according to basic diseases and blood test indexes before liver transplantation.