TEG在原位肝移植中凝血功能监测.doc

TEG在原位肝移植中凝血功能监测 　　[摘要] 目的 探讨对应用血栓弹力图（TEG）在原位肝移植患者围手术期间对凝血功能的监测，判定在指导应用血液制品方面的价值。 方法 回顾性分析我院2006年1月～2012年12月所收治的30例行原位肝移植患者的临床资料，分别于术前、无肝期、新肝期、关腹时抽取血液标本，测定常规凝血功能以及TEG，TEG参数包括反应时间、α角、K值、最大振幅。根据以上参数指导应用血液制品，反应时间7 min给予新鲜冰冻血浆；α角低于32°时给予Fg；最大振幅低于54 mm给予血小板，术后评价凝血功能的控制效果。 结果 30例患者经采用血液制品来调控机体凝血功能后，在无肝期、新肝期、手术完毕时均保持在轻度低凝状态，其常规凝血功能、TEG指标与手术前相比较差异无统计学意义（P0.05），术中调控效果满意，术后均未出现血栓栓塞性相关的并发症。 结论 TEG在肝移植中可以很好的监测凝血功能，并为其调控提供依据。 [关键词]血栓弹力图；原位肝移植；凝血功能；血液制品；监测 [中图分类号] R657.3 [文献标识码] B [文章编号] 2095-0616（2013）13-215-02 Coagulation function monitoring of TEG in orthotopic liver transplantation LIANG Jingzhu Department of Anesthesiology，the People’s Hospital of Zhongshan City， Zhongshan 528400，China [Abstract] Objective To discuss the coagulation function monitoring of thrombelastogram（TEG） in orthotopic liver transplantation，and judge the value in guiding and applying blood products. Methods The clinical datas of 30 cases with orthotopic liver transplantation in our hospital from January 2006 to December 2012 were analyzed retrospectively. The routine coagulation function and TEG indexes including reaction time，α angle，K value and maximum crest were detected during before operation，anhepatic phase，neohepatic stage and abdominal closure respectively.The blood products were guided and applied according to TEG indexes：fresh frozen plasma was given when reaction time was more than 7 minutes；Fg was given when α angle was less than 32°；blood platelet was given when maximum crest was less than 54mm.The controlling effect of coagulation function was evaluated after the operation. Results The coagulation function of 30 cases used blood products were mild and low during anhepatic phase，neohepatic stage and abdominal closure，and compared with during before operation，the difference of routine coagulation function and TEG indexes were not significant（P0.05）. The controlling effect during the operation was satisfactory，and no thromboembolic complications happened. Conclusion TEG can