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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。
OBJECTIVE: To analyze the perioperative blood transfusion in 127 patients with liver transplantation and provide the basis for the scientific, safe and rational blood transfusion in the perioperative period of liver transplantation. Methods: A retrospective study was conducted to observe the transfusion of blood components in 127 patients with liver transplantation and the results of postoperative thromboelastography (TEG) in some patients. The levels of suspended erythrocytes, fresh frozen plasma, platelets, Cold precipitation infusion situation. Results: Perioperative transfusion of blood was 5 011.5 ml in 127 cases of liver transplantation, accounting for 0.5% preoperatively, accounting for 76.3% in operation and 23.2% in operation. The ratio of suspended erythrocytes to fresh frozen plasma before operation, intraoperative and postoperative Respectively, 1.38: 1.00, 1.58: 1.00, 1.17: 1.00. Hemoglobin level, platelet count and coagulation index were different in patients with different basic diseases. Hemoglobin value and platelet count in posthepatitic cirrhosis group were significantly lower than those in primary liver cancer group. In post-hepatitis cirrhosis group, prothrombin time (PT) ), Activated partial thromboplastin time (APTT) was significantly longer than the primary liver cancer group, fibrinogen content was lower than the primary liver cancer group; different underlying diseases affect the amount of blood transfusion during perioperative liver transplantation, including posthepatitic cirrhosis group Intraoperative infusion of plasma, cryoprecipitate and platelets significantly increased compared with primary hepatocellular carcinoma; postoperative hepatic cirrhosis infusion of cryoprecipitate and platelets significantly increased compared with primary hepatocellular carcinoma. Of the 127 liver transplant recipients, 46 received postoperative TEG. The results showed that the patients had low coagulation status. The main findings were decreased fibrinogen activity and decreased platelet activity. Among them, clotting factor activity and fibrinogen function in patients with posthepatitic cirrhosis Lower than the primary liver cancer group. CONCLUSIONS: Choosing a scientific, safe and rational blood transfusion regimen is crucial to the success rate of liver transplantation and the prognosis of patients during perioperative period of liver transplantation due to different underlying diseases. TEG detection can guide perioperative blood transfusion of liver transplantation.