肝素残余作用对不伴感染肝移植术中凝血功能的影响.docVIP

肝素残余作用对不伴感染肝移植术中凝血功能的影响 周脉涛 俞卫锋 李泉 杨立群 刘志强 尤圣武 徐学武 【摘要】目的 研究肝移植供肝保养液加与不加肝素对再灌注后肝素血药浓度和凝血功能的影响，探讨内源性和外源性肝素在肝移植灌注后凝血功能的作用。方法 终末期肝病患者42例，均未合并细菌感染。根据保养液肝素不同使用方法分为两组，组Ⅰ保养液中加肝素25000U/L，组Ⅱ(n=18)不加肝素。两组均在新肝再灌注后-15、5、30、60、90、120、150min取血，高效液相色谱法检测肝素血药浓度，并同时作Sonoclot分析。结果 组Ⅰ在再灌注后各点Sonoclot玻璃珠激活凝血时间（gbACT）显著延长（p0.01）；再灌注5min肝素血药浓度315.3±55.2U/L，120min降至103.2±24.3U/L；肝素酶校正后gbACT与校正前差异显著（p0.01）；组Ⅱ再灌注后5min gbACT无显著改变（p＞0.05）；再灌注后30、60min gbACT有延长，但尚无统计学意义；90min以后gbACT逐渐回复正常。结论 无感染肝移植患者再灌注后短时间内产生的凝血紊乱与冲入循环的保养液肝素有关，而与内源性肝素无关。UW液不加肝素再灌注后短时间内凝血功能无明显影响。 【关键词】　肝素；肝移植；凝血异常；Sonoclot The remnant effect of heparin in the storage solution on coagulation during the orthotopic liver transplantation. Zhou Mai-tao, Yu Wei-feng, Li Quan , et al. Department of Anesthesia, Eastern Hepatobiliary Surgical Hospital , Second Military Medical University , Shanghai 200438 【Abstract】 Objective To investigate the effect of heparin in the cold storage solution on the coagulation function during liver transplantation(OLT). Methods 42 patients with cirrhosis or neoplasm of liver undergoing OLT were studied. None of them was infected with bacteria. They were divided into two groups: Group Ⅰ(n=18) receive donating liver with heparin over 25000U/L in the cold storage solution; GroupⅡ (n=24) without heparin. Anesthesia was induced with propofol 1.5～2mg/kg, fentanyl 3～5μg/kg and rocuronium 0.5mg/kg and maintained with isoflurane or desflurane inhalation. Central venous blood samples were drawn from the existing central venous line for determination of glass ball-activated Sonoclot and blood concentration of heparin at 7 time points: 15min before the reperfusion and 5,30,60,90,120,180 min after. Heparinase-glass ball Sonoclot of 9 patients from Group I was measured 5min after reperfusion in addition to glass ball Sonoclot. If there was significant difference in traces between two Sonoclot measurements, an IV bolus of 0.6mg/kg protamine was given. The determination of plasma heparin was by high performance l