国际外科学杂志
國際外科學雜誌
국제외과학잡지
INTERNATIONAL JOURNAL OF SURGERY
2010年
1期
38-40
,共3页
肝移植%凝血%血栓弹性图%Sonoclot凝血及血小板功能分析仪
肝移植%凝血%血栓彈性圖%Sonoclot凝血及血小闆功能分析儀
간이식%응혈%혈전탄성도%Sonoclot응혈급혈소판공능분석의
Liver transplantation%Blood coagulation%TEG%SCA
目的 探讨肝移植术中凝血功能的变化和Sonoclot凝血及血小板功能分析仪(sonoct coagution & piatelet function analgzer,SCA)在肝移植术中的应用.方法 24例择期肝移植手术患者全部采用原位经典非转流手术方法.于麻醉诱导前(TO)、手术开始后60 min(T1),无肝期30 min(T2)、新肝期30 min(T3)、新肝期120 min(T4)和术毕(T5)时分别采集桡动脉血检测,硅燥土激活的全血血栓弹性描记图(thrombelastography,TEG),指标包括R值、K值、Alpha角和MA值;玻璃珠激活的全血SCA,指标包括ACT、CR和PF值;常规凝血指标包括PT、APTT、INR、Fbg和Plt.结果 (1)SCA和TEG诊断凝血因子缺乏、纤维蛋白凝胶形成速度和血小板功能(都正常或者都异常)的Kappa值分别是0.371(P<0.05)、0.363(P<0.05)、0.438(P<0.05).gbACT与R、CR与α角、PF与MA呈正相关(r=0.790,P<0.05;r=0.766,P<0.05;r=0.502,P<0.05),CR与K呈负相关(r=-0.588,P<0.05).(2)与T0时比较,T3～T5时PT、INR、gbACT及R延长和FBG、CR、α及MA降低(P<0.05),T1～T5时APTT、T3时K延长(P<0.05),T2～T4时PF降低.结论SCA能够准确地监测肝移植术中凝血功能的变化.
目的 探討肝移植術中凝血功能的變化和Sonoclot凝血及血小闆功能分析儀(sonoct coagution & piatelet function analgzer,SCA)在肝移植術中的應用.方法 24例擇期肝移植手術患者全部採用原位經典非轉流手術方法.于痳醉誘導前(TO)、手術開始後60 min(T1),無肝期30 min(T2)、新肝期30 min(T3)、新肝期120 min(T4)和術畢(T5)時分彆採集橈動脈血檢測,硅燥土激活的全血血栓彈性描記圖(thrombelastography,TEG),指標包括R值、K值、Alpha角和MA值;玻璃珠激活的全血SCA,指標包括ACT、CR和PF值;常規凝血指標包括PT、APTT、INR、Fbg和Plt.結果 (1)SCA和TEG診斷凝血因子缺乏、纖維蛋白凝膠形成速度和血小闆功能(都正常或者都異常)的Kappa值分彆是0.371(P<0.05)、0.363(P<0.05)、0.438(P<0.05).gbACT與R、CR與α角、PF與MA呈正相關(r=0.790,P<0.05;r=0.766,P<0.05;r=0.502,P<0.05),CR與K呈負相關(r=-0.588,P<0.05).(2)與T0時比較,T3～T5時PT、INR、gbACT及R延長和FBG、CR、α及MA降低(P<0.05),T1～T5時APTT、T3時K延長(P<0.05),T2～T4時PF降低.結論SCA能夠準確地鑑測肝移植術中凝血功能的變化.
목적 탐토간이식술중응혈공능적변화화Sonoclot응혈급혈소판공능분석의(sonoct coagution & piatelet function analgzer,SCA)재간이식술중적응용.방법 24례택기간이식수술환자전부채용원위경전비전류수술방법.우마취유도전(TO)、수술개시후60 min(T1),무간기30 min(T2)、신간기30 min(T3)、신간기120 min(T4)화술필(T5)시분별채집뇨동맥혈검측,규조토격활적전혈혈전탄성묘기도(thrombelastography,TEG),지표포괄R치、K치、Alpha각화MA치;파리주격활적전혈SCA,지표포괄ACT、CR화PF치;상규응혈지표포괄PT、APTT、INR、Fbg화Plt.결과 (1)SCA화TEG진단응혈인자결핍、섬유단백응효형성속도화혈소판공능(도정상혹자도이상)적Kappa치분별시0.371(P<0.05)、0.363(P<0.05)、0.438(P<0.05).gbACT여R、CR여α각、PF여MA정정상관(r=0.790,P<0.05;r=0.766,P<0.05;r=0.502,P<0.05),CR여K정부상관(r=-0.588,P<0.05).(2)여T0시비교,T3～T5시PT、INR、gbACT급R연장화FBG、CR、α급MA강저(P<0.05),T1～T5시APTT、T3시K연장(P<0.05),T2～T4시PF강저.결론SCA능구준학지감측간이식술중응혈공능적변화.
Objective To determine intra-operative changes in blood coagulation and the applicability of SCA in liver transplantation. Methods Twenty-four patients with end-stage liver disease undergoing or-thotopic Liver transplantation (OLT) were studied. Arterial blood samples were drawn for determination of celite-activated TEG, glass bead-activated SCA and RCT at 6 intervals: before anesthesia induction (T0), 60 min after operation was started (T1), 30 miu in anhepatic phase (T2), 30 min in neohepatic phase (T3) ,120 min in neohepatic phase (T4) and the end of the operation (T5) ; the variables of TEG includ-ed: reaction time(R) ,coagulation time(K), alpha angles (α) and maximal amplitude (MA) ; the variables of SCA included: activated clotting time (ACT), clot rate (CR) and platelet function(PF) ;RCT included: Plt, PT, INR, APTT, Fbg. Results The Kappa values of SCA and TEG diagnosing the deficiency of blood coagulation factors, the gel formation speed of fibrin and the function of platelet were respectively 0.371 (P < 0.05) ,0. 363 (P < 0.05) ,0.438 (P < 0.05). gbACT and R, CR and α, PF and MA were positive-ly correlative (r = 0. 790, P < 0.05 ; r = 0. 766, P < 0. 05 ; r = 0. 502, P < 0.05 ; respectively) ; CR and K were negatively correlative(r = -0. 588,P <0.05). Compared with T0, PT, INR, gbACT and R were pro-longed, FBG, CR, α and MA were decreased at T3-5 (P < 0.05). APTT was prolonged at T1 ～ T5 (P < 0.05). K was prolonged at T3 (P < 0.05) and PF was decreased at T2 ～ T4. Conclusion SCA can exactly monitor changes of blood coagulation in liver transplantation.
