肝移植患者围手术期成分输血分析与评估

发布时间：2018-05-05 12:04

本文选题：肝移植 + 成分输血　；参考：《临床血液学杂志(输血与检验)》2016年06期

【摘要】：目的:分析127例肝移植患者在围手术期的成分输血情况,为肝移植术围手术期科学、安全、合理输血提供依据。方法:以回顾性研究方法观察127例肝移植患者成分输血情况及部分患者术后血栓弹力图检测(TEG)结果,分析术前、术中和术后各期悬浮红细胞、新鲜冰冻血浆、血小板、冷沉淀的输注情况。结果:127例肝移植患者围手术期人均输血5 011.5ml,术前占0.5%,术中占76.3%,术后占23.2%;术前、术中、术后悬浮红细胞与新鲜冰冻血浆的比例分别为1.38∶1.00,1.58∶1.00,1.17∶1.00。不同基础疾病组患者术前血红蛋白水平、血小板计数和凝血指标存在差异,其中肝炎后肝硬化组血红蛋白值、血小板计数均显著低于原发性肝癌组;肝炎后肝硬化组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)显著长于原发性肝癌组,纤维蛋白原含量低于原发性肝癌组;不同基础疾病影响肝移植围术期成分输血量,其中肝炎后肝硬化组术中输注血浆、冷沉淀及血小板较原发性肝癌组显著性增多;肝炎后肝硬化组术后输注冷沉淀及血小板较原发性肝癌组显著性增多。127例肝移植患者中有46例接受术后TEG检测,结果提示患者为低凝状态,主要表现为纤维蛋白原活性降低、血小板活性降低,其中肝炎后肝硬化组凝血因子活性及纤维蛋白原功能均低于原发性肝癌组。结论:针对不同基础疾病所致肝移植术围手术期,选择科学、安全、合理的输血方案对肝移植成功率及患者预后至关重要,TEG检测对肝移植围手术期成分输血具有指导作用。
[Abstract]:Objective: to analyze the blood component transfusion in 127 patients with liver transplantation during perioperative period, so as to provide scientific, safe and reasonable basis for the perioperative transfusion of liver transplantation. Methods: a retrospective study was carried out to observe the blood component transfusion in 127 patients with liver transplantation and the results of thromboelastography (TEG) in some patients. The suspended red blood cells, fresh frozen plasma and platelets were analyzed before, during and after liver transplantation. The infusion of cryoprecipitation. Results during the perioperative period, the blood transfusion was 5011.5ml per person in 127 patients with liver transplantation, 0.5 ml before operation, 76.3ml during operation and 23.2ml after operation, and the ratio of suspended red blood cells to fresh frozen plasma was 1.38: 1.00 1.58: 1.00 1.17: 1.00 before and after operation, and the ratio of suspended red blood cells to fresh frozen plasma was 1.38: 1.00, 1.58: 1.00 and 1.17: 1.00, respectively. There were significant differences in preoperative hemoglobin level, platelet count and coagulation index among patients with different basic diseases. The hemoglobin level and platelet count in posthepatitic cirrhosis group were significantly lower than those in primary liver cancer group. The prothrombin time (PTT) and activated partial thromboplastin time (APTT) in posthepatitic cirrhosis group were significantly longer than those in PHC group, and the fibrinogen content was lower than that in PHC group. The intraoperative infusion of plasma, cryoprecipitation and platelet in posthepatitic cirrhosis group was significantly higher than that in primary liver cancer group. Postoperative cryoprecipitation and platelets were significantly increased in posthepatitic cirrhosis group. 46 out of 127 liver transplantation patients were examined by TEG. The results showed that the patients were in a low coagulation state and showed decreased fibrinogen activity. The thromboplastin activity and fibrinogen function in patients with posthepatitic cirrhosis were lower than those in patients with primary liver cancer. Conclusion: according to the perioperative period of liver transplantation caused by different basic diseases, it is very important to select scientific, safe and reasonable blood transfusion protocol for the success rate of liver transplantation and the prognosis of patients.
【作者单位】：南京医科大学第一附属医院输血科;
【基金】：南京市科技计划项目资助(No:201303037)
【分类号】：R657.3;R457.1

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