摘要
目的观察重型肝炎和肝癌病人肝移植围术期凝血功能的变化。方法重型肝炎组(H组)8例病人和肝癌组(N组)11例病人接受肝移植术。于术前(T0)、手术1h(T1)、无肝10min(T2)、新肝5min(T3)、新肝3h(T4)测定凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、血小板计数(Plt)、纤溶酶活性,并测定激活凝血时间(ACT)、凝血速率(clotrate)及血小板功能(PF)。结果两组T1、T2时凝血指标改善(P<0.05);T3时ACT、TT、APTT延长,Plt、PF降低,纤溶酶活性增强(P<0.05,P<0.01);T4时APTT延长(P<0.05,P<0.01)。N组各时点clotrate、Fib、Plt高于H组;T1、T2和T4时TT和APTT低于H组;输注凝血物质的量少于H组(P<0.05)。结论重型肝炎和肝癌病人肝移植术围术期凝血功能变化趋势一致;重型肝炎病人需要加大凝血物质的使用量。
Objective To observe the changes of coagulation function during liver transplantation in patients with severe heptitis and liver cancer. Methods Nineteen patients with end-stage liver disease undergoing orthotopic liver transplantation（OLT） were assigned into severe＇ hepatitis group （group H,n=8）, and liver cancer group（group N,n= 11）. During operation, blood samples were drawn for determination of prothrombin time （PT）, thromboplastin time （TT）, activated partial thromboplastin time （APTT）, fibrinogen concentration （Fib）, platelet count （Plt） and activity of fibrinolysin （PL）before induction（T0 ）, at l h during operation （T1）, 10 rain after liver removal （T2）, 5 rain after reperfusion（T3 ） ,and 3h after reperfusion（T4 ）. At the same times, ACT,clot rate,and platelet function were monitored by Sonoclot analysis. All the coagulant and anti-fibrinolytic drugs were recorded. Results PT,ACT,TT and PL decreased significantly （P〈0.05） at T1 or T2 compared to T0 in group H,and TT decreased significantly at T1 ,T2 compared to To in group N（P〈0.05）. ACT, TT,APTT,PL increased significantly,the clot rate,Fib,Pit and PF decreased significantly at T3 in both groups（P〈0.05, P〈0.01）. APTT increased significantly at T4 in both groups（P〈 0.05, P〈 0.01）. The clot rate,Plt,PF,and Fib in group H were less than those in group N during operation（P 〈0.05）. TT and APTT in group H were more than those in group N at T1 ,T2 and T4. There was a significant difference in the usage of coagulant and anti-fibrinolytic drugs between two groups（P〈 0.05）. Conclusion The changes of coagulation function during liver transplantation between two groups were similar. The patients in group H needed more coagulant and anti-fibrinolytic drugs.
出处
《临床麻醉学杂志》
CAS
CSCD
2006年第5期321-323,共3页
Journal of Clinical Anesthesiology
关键词
重型肝炎
肝癌
肝移植
凝血
Severe hepatitis
Liver cancer
Liver transplantation
Coagulation
