纤维蛋白原对肝外科凝血功能影响的临床研究

Clinical Study of the Influence of Fibrinogen on the Coagulant Function after Liver Surgery

目的:研究凝血因子在肝移植手术过程中的变化及补充纤维蛋白原(Fib)对肝外科术后凝血功能的影响。方法:9例肝移植患者,分别检测术前,术中无肝前期(Ⅰ期)、无肝期(Ⅱ期)和供肝期(Ⅲ期)及术后第3d的凝血酶原时间(PT),白陶土部分凝血活酶时间(KPTT)和Fib。57例肝切除术后第3d PT高于13.0s,Fib低于300mg·dl-1,随机分成应用Fib组和对照组,隔天静脉滴注Fib 1～2g。结果:肝移植组术中Ⅱ期PT、KPTT明显延长,Fib显著下降,与术前、术后相比差别有高度统计学意义(P<0.001),尽管术中Ⅲ期凝血指标有所改善,但与术前、术后相比差别仍有统计学意义(P<0.05)。对于伴有低纤维蛋白原血症且PT延长的患者,应用Fib能够使PT时间缩短,Fib水平提高,与对照组相比,差别具有统计学意义(P<0.05)。结论:肝移植术中凝血因子明显减少,凝血指标明显异常,尤以无肝期明显。在补充其他凝血因子的同时,选择性应用Fib更有助于改善肝外科术后凝血功能的异常。

Objective: To observe pre- , intra - and post - operative changes coagulation factors in liver transplantation and to value the effect of additional fibrinogen on coagulant function after liver surgery. Methods: 9 patients underwent orthotopic liver transplantation (OLT), prothrombin time (PT), kaolin partial thromboplastic time (APTT) and fibrinogen (Fib) were measured in the pre- , intra- and post - operative period of OLT, respectively. 57 patients underwent liver resection were randomly assigned to control group (n =27) or fibrinogen group (n = 30), whose PT increased more than 13.0 second and whose fibrinogen reduced to less than 300 mg·dl-1. The patients received fibrinogen 1 to 2 g every other day. Fibrinogen was administered by intravenous injection. Results: PT and APTT elevated significantly; Fib descended significantly during the anhepatic period (stage II) of OLT. These changes reached statistical significance, compared to pre- or post - operation (P< 0.001). Although PT, APTT decreased slightly and fibrinogen increased slightly during the donor hepatic period (stage III) of OLT, significant difference were observed,compared to pre- or post - operation (P<0.05). Administration of fibrinogen could contribute to the decline of PT or APTT and to elevation of fibrinogen for the patients underwent liver resection with lower fibrinogen and Conger PT. The level of PT and fibrinogen in the fibrinogen group significantly differed from that in the control group (P<0.05). Conclusion: Coagulation factors obviously declined and index of coagulation was distinctly abnormal during the OLT, especially in the stage II. Selective administration of Fib contributes to recovery of coagulation function, as well as the use of platelet, plasma and other coagulation factors.