摘要
目的 研究原位肝移植手术中的血液保护。方法 35例行原位肝移植手术的病人 ,随机为分A、B两组。A组 2 0例 ,术中采用洗涤式自体血回收和大剂量抑肽酶的血液保护措施 ;B组 15例 ,不使用上述血液保护方法。A、B两组均加强血液动力学、体温、凝血功能监测包括活化部分凝血酶时间 (APTT)、凝血酶时间 (TT)、凝血酶原时间 (PT)、纤维蛋白原定量 (FIB)、激活全血凝血时间(ACT)、凝血弹性图 (TEG) (取R值作为观察指标 )。并统计两组术中失血量和输血量、A组回收的血量和回输的洗涤红细胞量。两组病人均在无肝期采用静脉 静脉转流。术中保持正常体温并于新肝期中和肝素。结果 A组平均出血量 (315 2± 16 35 )ml,B组 (4 2 6 5± 15 45 )ml(P <0 0 5 )。A组平均每例回收血量 (2 6 6 2± 1135 )ml,回输洗涤红细胞 (1310± 710 )ml。A组平均输血量 (2 410±95 0 )ml,B组 (2 886± 10 10 )ml(P <0 0 5 )。在凝血功能各项中 ,转流 30、6 0分钟、新肝期 15分钟及术毕时 ,A组各指标均优于B组 (P <0 0 5 ,P <0 0 1)。结论 原位肝移植术中应用相应的血液保护方法能节省用血 ,加强凝血功能的监测并予针对性处理 。
Objective To study the strategies of blood conservation during orthotopic liver transplantation (OLT).Methods 35 patients with end-stage liver disease undergoing OLT were randomly divided into 2 groups.A large dose of aprotinin and intraoperative blood cell saver were used in group A (n=20),but patients in group B (n=15) did not receive the strategies mentioned above.Veno-venous bypass was applied to all the cases during anhepatic phase.Hemodynamics,coagulation variables and body temperature were monitored at 4 intervals:pre-anesthesia,extracorporeal veno-venous shunt 15min and 30min,15min after reperfusion as well as the end of operation.The coagulation variables included activated partial thromboplastin time(APTT),thrombin time (TT),prothrombin time(PT),fibrinogen(FIB),activated clotting time(ACT) and R value of thrombelastography (TEG).All patients were kept body temperature stable during operation and residual heparin was neutralized with protamin.Results The blood loss in group B was (4*!265± 1*!545)ml,which was significantly more than that of group A (P<0.05).The patients in group A received (2*!410±950)ml of homologous blood,which was markedly less than that ( 2*!886± 1*!010)ml of group B(P<0.05). (1*!310±710)ml of autoblood washed red cell was transfused in group A.Each item of coagulation function in group A was better than that in group B(P<0.05,P<0.01).Conclusions Taking appropriate strategies of blood conservation and intensifying the coagulation monitoring during OLT may decrease the amount of homologous blood transfusion.
出处
《临床麻醉学杂志》
CAS
CSCD
2002年第7期345-347,共3页
Journal of Clinical Anesthesiology
