肝脏移植手术期间抗凝血酶和纤维蛋白溶解功能的变化

The changes of antithrombin and fibrinolyic function during the liver transplantation in chronic end-stage liver patients

目的探讨肝脏移植围手术期及恢复期抗凝血酶和纤维蛋白溶解功能的变化及临床意义。方法观察了17例终末期肝病患者在肝脏移植手术期间血浆抗凝血酶活性(AT:A)、纤溶酶原活性(PLG:A)、血浆D-二聚体(D-D)、纤维蛋白(原)降解产物(FDP)、纤维蛋白原(FIB)含量的动态变化。所有患者均于术前、无肝前期、无肝期15min、新肝期5 min、新肝期30 min、术毕、术毕6h、术毕4d抽取桡动脉血,在STAGO-STA自动血凝仪上用发色底物法测定AT:A和PLG:A;免疫比浊法测定D-D; 凝固法测定(FIB)含量及用ELISA法测定FDP含量,并将各指标在移植过程中的变化进行分析。结果 AT:A在手术开始有持续下降趋势(P【0.05),新肝植入后开始回升,术毕6h明显高于术前并逐渐上升(P【0.05和P【0.01);PLG:A和FIB在无肝前期就开始呈下降趋势,而FDP呈上升趋势(分别为P(0.05和P【0.01),直至术毕6h PLG:A和FIB才恢复至术前水平(P】0.05),随后逐渐上升,术后第4 d显著高于术前(P【0.01),FDP术后第4 d有所下降,但仍然高于术前(P【0.01); D-D于术毕和术毕6 h显著高于术前(P【0.05)。结论肝脏移植手术期间血浆抗凝血酶活性降低,纤溶功能亢进;肝脏移植恢复期抗凝血酶活性和纤溶功能的恢复是衡量肝脏移植成功的较好指标之一。

Objective To investigate the changes of antithrombin and fibrinolyic function during liver transplantation in chronic endstage liver disease. Methods 17 consecutive patients were included in the this studies. Antithrombin activity (AT;A) 、plasminogen activity ( PLG:A) 、D-dimer (D-D) and fibrinogen (FIB) 、fibrin degradation production (FDP) and other coagulation parameters were examined during the clinical courses of liver transplantation. All the samples were obtained at preoperative stage, at pre-anhepatic stage, at anhepatic stage, the 5th min after blood reperfusion, the thirty min after blood reperfusion, the sixth hour after operation, and the 4th day after operation, and all parameters were analyzed through STAGO-STA. Results: In contrast to preoperative stage AT:A gradual decrease before blood reperfusion( P <0.05) , began to be increasd after reperfusion, and increased significantly on the 6th day after operation ( P <0. 05 and P <0. 01 respectively). PLG:A and FIB showed decrease in pre-anhepatic stage,but FDP was increased ( P < 0. 05 and P < 0. 01 , respectively). 6hours after operation PLG: A and FIB were reincreased to the level of preoperation ( P > 0. 05) ,and then were increased gradually and at the 4th day after operation significantly increased compared with preoperation (P <0.01) ; FDP decreased the 4th day after operation while still higher than preoperation (P < 0. 01) ; D-D increased significantly after operation (P < 0. 05). Conclusion: AT: A was decreased gradually and fibrinolyic function were sthenic during the courses of liver transplantation. it was very important to measure AT:A ,PLG:A and other coagulation parameters during the courses of liver transplanting patients.