摘要
目的探讨肝移植新肝早期凝血功能障碍的处理.方法17例肝硬化或肝豆状核变性病人在全麻下行活体部分供肝或尸肝移植.全身麻醉采用静注咪唑安定0.1mg/kg,丙泊酚1mg/kg,芬太尼0.3μg/kg及维库溴铵0.15mg/kg行气管插管后,接呼吸机间歇正压通气(IPPV)并加呼气末正压通气(PEEP)5cmH2O.术中除持续监测循环、呼吸、体温变化外,间断监测生化、血常规及凝血指标.凝血指标包括激活全血凝血时间(ACT)、凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)和血小板(PLT)的量.结果与无肝前期相比,无肝期及新肝早期存在严重凝血功能障碍(P<0.05).结论在严密监测凝血指标的前提下,采用血制品的输入如新鲜冰冻血浆、冷沉淀、血小板、凝血酶原复合物及使用血液回收机自体血回输,抑肽酶持续微泵注射,应用少量鱼精蛋白等综合措施能有效纠正新肝早期凝血功能障碍,有条件时用血栓弹力描记仪更有助于指导凝血功能的纠正.
OBJECTIVE To investigate the management of coagulation disorders at earlier period of neograft during liver transplantation. METHODS 17 orthotopic or living related liver transplantation were performed in patients with cirrhosis or Wilson disease under general anesthesia. Midazolam 0.1 mg/kg, propofol 1mg/kg, fentanyl 0.3 μg/kg and vecuronium 0.15 mg/kg were intravenously injected sequentially for general anesthesia. After intubation, intermittent positive pressure ventilation(IPPV) adding positive end expiratory pressure (PEEP)0.5 cm H 2 O were carried out throughout the operation. During operation , the circulation, respiration, temperature, blood chemistry, blood routine and clotting index were monitored. The blood clotting index included activated clotting time (ACT), prothrombin time(PT), thrombin time(TT), activated partial thromboplastin time(APTT), fibrinogen (Fbg)and platelet(PLT). RESULTS As compared to pre-anhepatic phase, the coagulaion disorders in anhepatic and reperfused phase were significantly different(P<0.05). CONCLUSIONS Blood products such as fresh frozen plasma, cryoprecipitate, platelet and prothrombin compound were very helpful to improve the coagulation function. Aprotinin and protamine also did good to the coagulation function. Meanwhile autoblood back-transfusion and thromboelastography were made use for saving blood products and convenient to guide the correction of coagulation disorders.
出处
《江南大学学报（自然科学版）》
CAS
2005年第3期328-330,共3页
Joural of Jiangnan University (Natural Science Edition)
基金
江苏省自然科学基金项目(BJ98025)资助课题
关键词
肝移植
新肝早期
凝血障碍
liver transplantation
neograft
coagulation disorders
