Hase Tetsutaro, Takita Koichi, Hashimoto Toshikazu, Morimoto Yuji
Department of Anesthesiology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638.
Masui. 2011 Jul;60(7):840-5.
Continuous epidural analgesia has become an accepted technique used in laparotomy including liver resections. Although American Society of Regional Anesthesia and Pain Medicine recommends that epidural catheter be removed with prothrombin time-international normalized ratio (PT-INR) less than 1.5, it is possible that liver surgery causes coagulation disturbances. We examined the postoperative changes in coagulation profiles of living liver donors to elucidate whether hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters or not.
From January 2007 to October 2009, 42 living liver related transplantations were performed in Hokkaido University Hospital. We reviewed the donor data including PT-INR obtained during perioperative days [preoperative, immediately postoperative, postoperative day 1, 3 and 7] and epidural catheter-related-complications, retrospectively.
While in all donors values of PT-INR obtained during preoperative periods were within normal limits, 14 donors had a PT-INR over 1.5 during postoperative periods. There was no epidural hematoma case in this study.
Our study suggested that hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters, even in the living liver transplant donors with normal liver function.
连续硬膜外镇痛已成为包括肝切除术在内的剖腹手术中被广泛接受的技术。尽管美国区域麻醉与疼痛医学学会建议在凝血酶原时间-国际标准化比值（PT-INR）小于1.5时拔除硬膜外导管，但肝手术仍有可能导致凝血功能紊乱。我们研究了活体肝供者术后凝血指标的变化，以阐明肝切除术是否会增加与拔除硬膜外导管相关的硬膜外血肿风险。
2007年1月至2009年10月，北海道大学医院进行了42例活体肝相关移植手术。我们回顾了供者数据，包括围手术期（术前、术后即刻、术后第1、3和7天）获得的PT-INR以及与硬膜外导管相关的并发症。
所有供者术前的PT-INR值均在正常范围内，但14例供者术后PT-INR超过1.5。本研究中无硬膜外血肿病例。
我们的研究表明，即使是肝功能正常的活体肝移植供者，肝切除术也会增加与拔除硬膜外导管相关的硬膜外血肿风险。
