肝移植术中血浆输注对肝功能及凝血功能的影响

Effects of plasma infusion on liver function and coagulation function during liver transplantation

目的 对患者术前及术后24 h内临床指标进行对比,分析肝移植手术中血浆输注对患者肝功能、凝血功能以及预后的影响。方法 回顾性分析2018年1月-2021年6月本院同种异体肝移植术患者150例,根据术中是否输注血浆分为输血浆组与非输血浆组,比较2组间临床指标的变化。结果 术中输血浆组患者血小板(PLT)指标低于非输血浆组;凝血酶原时间(PT)、国际标准化比值(INR)、凝血酶时间(TT)、终末期肝病模型(MELD)评分、ICU住院天数、住院天数等指标均高于非输血浆组,差异均有统计学意义(P<0.05)。采用ROC曲线预测术中输注血浆,凝血酶原时间(PT)的曲线下面积最高(0.644)。经多因素Logistic回归分析,患者术前凝血酶原时间(PT)是术中血浆输注的独立危险因素。结论 术中输血浆组的患者凝血功能、肝功能指标较差,终末期肝病患者术前调整肝功能和凝血功能是防止术中大量出血、增强手术后预后的方式之一。

Objective The clinical indexes before and within 24 hours after liver transplantation were compared, and the effects of plasma infusion on liver function, coagulation function and prognosis were analyzed.Methods A total of 150 patients undergoing liver allograft transplantation in our hospital from January 2018 to June 2021 were retrospectively analyzed. They were divided into plasma transfusion group and non-plasma transfusion group according to whether plasma was infused during the operation. The changes of preoperative clinical indexes and postoperative prognostic indexes between the two groups were compared.Results The index of platelet(PLT) in the plasma transfusion group was lower than those in the non-plasma transfusion group;prothrombin time(PT), international normalized ratio(INR), thrombin time( TT), score of model for endstage liver diease(MELD), ICU hospitalization days and hospitalization days in plasma transfusion group were significantly higher than those in non-plasma transfusion group, with the differences statistically significant(P< 0. 05). The area under the curve of prothrombin time(PT) was the highest(0. 644). Multivariate Logistic regression analysis showed that preoperative prothrombin time(PT) was independent risk factors for intraoperative plasma infusion.Conclusion The indexes of coagulation function and liver function in the plasma transfusion group were poor. Preoperative adjustment of liver function and coagulation function in patients with end-stage liver disease was one of the ways to prevent massive intraoperative bleeding and enhance postoperative prognosis.