Trzebicki Janusz, Flakiewicz Edyta, Kosieradzki Maciej, Blaszczyk Beata, Kołacz Marcin, Jureczko Lidia, Pacholczyk Marek, Chmura Andrzej, Lagiewska Beata, Lisik Wojciech, Wasiak Dariusz, Kosson Dariusz, Kwiatkowski Artur, Lazowski Tomasz
Department of Anesthesiology and Intensive Care, The Medical University of Warsaw, Poland.
Ann Transplant. 2010 Jul-Sep;15(3):19-24.
Bleeding due to fibrinolysis is a serious intraoperative complication during orthotopic liver transplantation (OLT). For a number of years aprotinin was used to minimize risk of this complication. This drug was however banned in 2007 and substituted with other antifibrinolytics. The aim of the study was to assess the potential of intraoperative thromboelastometry to evaluate hemostasis and channelize antifibrinolytic therapy.
MATERIAL/METHODS: Since ban on aprotinin, 39 patients underwent OLT in our center with no monitoring of fibrinolysis (NMF). Severe disturbances of hemostasis assessed clinically only as a need for blood and blood products transfusion and were treated with transfusion of fresh frozen plasma only. In 2008 we started to use thromboelastometry (ROTEM group, n=39), which allowed for targeted treatment of hyperfibrinolysis with tranexamic acid.
The need for blood transfusion in ROTEM group was insignificantly a lower than in NMF group (4.1±4.76 vs 5.53±4.89 units, p=0.2). Patients from ROTEM group required also less plasma transfusions (10.01±7.47 vs 13.15±6.62, p=0.06). Severe fibrinolysis was found in 3 patients from ROTEM group (7.7%) and was treated with tranexamic acid.
Thromboelastometry provides an immediate diagnosis of fibrinolysis, justifies implementation of targeted treatment and confirms effectiveness of the therapy. In a larger study group it can also result in significant minimization of blood products transfusion during OLT.
纤维蛋白溶解引起的出血是原位肝移植（OLT）术中的严重并发症。多年来，抑肽酶一直用于降低该并发症的风险。然而，这种药物在2007年被禁用，取而代之的是其他抗纤维蛋白溶解剂。本研究的目的是评估术中血栓弹力图在评估止血和指导抗纤维蛋白溶解治疗方面的潜力。
材料/方法：自抑肽酶被禁用以来，我们中心有39例患者接受了OLT，未进行纤维蛋白溶解监测（NMF）。仅根据临床评估严重的止血障碍为需要输血和血液制品，并仅用新鲜冰冻血浆进行治疗。2008年，我们开始使用血栓弹力图（ROTEM组，n = 39），这使得可以用氨甲环酸针对性治疗高纤维蛋白溶解。
ROTEM组的输血需求略低于NMF组（4.1±4.76单位对5.53±4.89单位，p = 0.2）。ROTEM组的患者也需要较少的血浆输注（10.01±7.47对13.15±6.62，p = 0.06）。ROTEM组有3例患者（7.7%）出现严重纤维蛋白溶解，并用氨甲环酸治疗。
血栓弹力图可立即诊断纤维蛋白溶解，为实施针对性治疗提供依据，并证实治疗的有效性。在更大的研究组中，它还可显著减少OLT期间的血液制品输注。
