肝移植围手术期出凝血功能障碍的防治

Prevention and treatment of bleeding and coagulation dysfunction during perioperative period of orthotopic liver transplantation

目的 探讨肝移植围手术期出凝血功能障碍的防治。方法 回顾性分析我院 2 0 0 2年 6月～ 2 0 0 3年 12月施行的 6 1例肝移植病例。结果 6 1例肝移植术前肝功能ChildC级 35例 (5 7 4 % ) ,ChildB级 2 6例 (4 2 6 % ) ,ChildC组的患者术中凝血指标 (INR)的变化程度大于ChildB组 (P <0 0 5 )。与凝血有关的并发症中大出血 5例 (8 2 % ) ,肾衰 6例 (9 8% ) ,肝动脉血栓形成 5例 (8 2 % ) ,手术开展两阶段对比 ,第二阶段主要因限制了大量凝血药及血制品的使用 ,并发症明显减少。结论 掌握好不同时期。

Objective To discuss the prevention and treatment of bleeding and coagulation dysfunction during perioperative period of OLT. Methods Clinical data of 61 cases with OLT from June 2002 to Dec. 2003 was analyzed retrospectively. Results The cases with liver function of Child C grade before operation were 35(57.4%), and Child B 26(42.6%). INR change degree in Child C group was larger than that in Child B(P<0.05). The cases of massive hemorrhage was 5(8.2%), renal failure 6(9.8%), and hepatic artery thrombosis 5(8.2%) in complications related to bleeding and coagulation function. The results were compared between two phases after the begining of OLT. Complications of the second phase declined remarkably because of restricting the use of massive coagulation drugs and blood products. Conclusions The key point of preventing and treating bleeding and coagulation dysfunction during peri-operative period of OLT is precisely regulating the balance between bleeding and thrombosis during different periods in different patients.