控制性低中心静脉压下原位肝移植术中凝血功能的变化

目的 观察控制性低中心静脉压（Low central venous pressure,LCVP）技术下,接受原位肝移植患者手术中各时期及术后凝血功能的变化. 方法 选择我院原位肝移植手术患者40例,随机分为正常CVP组（C组）和LCVP组（L组）,采用相同全身麻醉方式后,C组维持CVP在8～12 mmHg,L组将CVP降至4～5 mmHg,维持动脉收缩压≥90 mmHg,检测和记录肝移植各期和术后血小板水平、凝血功能相关指标、术中出血量、相关血制品输注量、术后引流情况及气管导管拔出时间. 结果 两组患者术前血小板及凝血功能各指标差异无统计学意义;C组患者中无肝期和新肝期1 h与无肝前期比较,PLT、Fg明显减少,TT、PT、APTT明显延长,L组患者移植各期PLT、TT、PT、Fg水平差异无统计学意义;L组与C组患者比较,移植各期PLT、Fg值增高,PT、APTT明显缩短;术中L组出血量较C组减少;患者血小板、凝血酶原复合物、冷沉淀输注总量均明显减少;L组患者肝上、肝下间隙引流管引流量减少,拔管时间缩短. 结论 LCVP技术应用于原位肝移植手术中,可改善术中凝血功能障碍,减少术中各类血制品输注及相关风险,有利于术后凝血功能的迅速恢复和缩短引流管放置时间,促进术后患者恢复.

Change of Coagulation Function during Orthotopic Liver Transplantation with the Manipulation of Low-central-venous-pressure Technique:A Clinical Controlled Trial

Objective To observe the change of coagulation function during orthotopic liver transplantation with the manipulation of Low-cen- tral-venous-pressure technique （ LCVP ） intra-and post-operatively. Methods Fourty patients scheduled for orthotopic liver transplantation were divided into 2 groups （n = 20 each） ：group C normal CVP;group L LCVP. Coagulation function, volume of blood loss, blood transfusion and the volume of drainage were measured every phase. All data were analysed in SPSSI3.0 with relevant methods. Results No statistical difference was found between the two groups on the baseline of platelet level and coagulation status. In group C ,PLT and Fg were significant lower, the time of TT, PT and AI：qT was significant longer than preoperation during operation. Compared with group C, PLT and Fg of group L were significant higher, the time of TI＇, PT and AFFI＂ was shorter. The volume of blood loss in group L was significantly smaller than group C. Blood components as platelet, prothrombin complex and cryoprecipitate were infused significantly less in group L during the operation, pa- tients in group L also reported less volume of pert-hepatic drainage and shortening of lower hepatic tubing extraction time post-operatively. Conclusions The technique of LCVP can be harnessed during orthotopic liver transplantation to attenuate disturbance of coagulation system and help quicken the recovery of haemostatic function, thus reducing the dose of transfusion of blood products, and lessened volume and short- ening of time of pert-hepatic drainage might also improve the outcome of patients post-operatively.