氨甲环酸联合急性等容性血液稀释在肝移植术的应用

摘要

目的 探讨氨甲环酸(TA)联合急性等容血液稀释(ANH)对肝移植手术患者围术期纤溶功能的影响.方法 选择肝移植手术患者30例,随机分为对照组(C组)、氨甲环酸组(T组)、氨甲环酸联合ANH组(T+A组),每组各10例.C组不做处理;T组于麻醉诱导后静脉注射负荷量20mg/kg氨甲环酸,然后以10mg/(kg·h)输注至新肝期2h;T+A组采用氨甲环酸和ANH联合应用.分别于麻醉诱导后即刻(T0)、无肝期30 min(T1)、新肝期30 min(T2)、新肝期2 h(T3)时取中心静脉血样,测定血红蛋白(Hb)、血小板计数(Plt)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、D-二聚体.记录术中出血量,异体红细胞和新鲜冰冻血浆输注量,纤维蛋白原用量,ICU停留时间及肝动静脉血栓栓塞等情况.结果 与T0比较,三组患者T1,T2时刻Hb,Plt及Fg含量均不同程度下降,而D-二聚体含量上升(P<0.05);与C组比较,T组和T+A组T1、T2、T3时刻D-二聚体浓度均下降(P<0.05).三组术中出血量及纤维蛋白原用量比较差异无统计学意义(P>0.05);与C组和T组比较,T+A组术后异体红细胞和新鲜冰冻血浆使用量显著降低(P<0.05).结论 氨甲环酸联合急性等容血液稀释自体输血可抑制肝移植手术患者的纤溶功能,节约血源效果明显且安全有效.%Objective To investigate the effects of tranexamic acid plus acute normovolemic hemodilution(ANH) in liver transplantation. Methods 30 ASA physical status Ⅱ～Ⅲ patients,aged 40～60 yr,scheduled undergoing liver transplantation were randomly divided into 3 groups (n=10):control group(group C),tranexamic acid group(group T) and tranexamic acid combined with ANH group(group T+A). No treatment in group C.After induction of anesthesia,tranexamic acid 20 mg/kg was intravenously infused in 30 min followed by continuous infusion at 10mg/kg·h until the end of operation in group T. Tranexamic acid was intravenously infused combined with ANH in group T+A. The samples were taken from the central venous blood immediately after induction of anesthesia(T0),anhepatic phase 30 min(T1),new liver stage of 30 min(T2), the new liver stage of 2 h(T3) respectively.The coagulation parameters such as Hb,Plt,PT,APTT,Fg,and D-Dimer were recorded successively. The amount of blood loss,the amount of fresh red blood cells and fresh frozen plasma,the amount of fibrinogen,the length of ICU stay,and hepatic venous thromboembolism were recorded. Results Compared with T0,the Hb,Plt and Fg decreased at T1,T2 in 3 groups patients,while D- two dimer content increased(P<0.05). Compared with C group,D- dimer concentration decreased(P<0.05) in T group and T+A group at T1,T2,T3. There was no significant difference between the 3 groups in the amount of bleeding and fibrinogen dosage(P>0.05). Compared with the C group and the T group,the amount of allogeneic red blood cells and fresh frozen plasma was significantly lower in the T+A group(P<0.05). Conclusion Tranexamic acid combined with acute normovolemic hemodilution in patients with liver transplantation can inhibit the fibrinolytic function,the blood conservation effect is obviously,safe and effective.