Minov A F, Dziadz'ko A M, Rummo O O
Anesteziol Reanimatol. 2012 Mar-Apr(2):35-41.
The purpose of the study. Optimum correction of hemostasis remains one of the unsolved problems in anesthesia maintenance during liver transplantation. Modern methods of coagulation monitoring (thromboelastography, thromboelastometry) allows to differ the increased bleeding reason. The clear criteria for the appointment of the blood components according to these methods have not developed so far. The aim of this study was to determine the criteria of hemostasis disorders correction during liver transplantation.
The study included all patients undergoing a liver transplantation in our clinic from January 2009 to December 2010. In certain intervals of time an intake of blood samples for the hemostasis study including koagulogramm, determination of the clotting factors and natural anticoagulants activity was performed.
There is no significant correlation between the results of the standard coagulation tests and thromboelastometry Based on the international hemostasis correction recommendations, with the help of ROC-analysis the search for thromboelastometry data, which would have pointed to the need for this therapy was made. Concerning coagulation factors deficiency (INR>2, APTT> 1.5) CT-EXTEM>80 has a sensitivity of 17% and a specificity of 97%, and CT-INTEM>240 has sensitivity of 51% and specificity of 96%. Use of A10-FIBTEM for fibrinogen deficiency diagnosis, A10-FIBTEM <9 has sensitivity of 95% and specificity of 63%. A simultaneous increase of CT-EXTEM >80 and CT-INTEM more than 300 has a sensitivity of 96% and a specificity 81% in relation to diagnose thrombocytopenia (platelet count less than 50,000 per mcl).
Correction of coagulation factors deficiency indicated when CT-EXTEM>80 and CT-INTEM> 240, hypofibrinogenemia when A10-FIBTEM <9, thrombocytopenia when of CT-EXTEM >80 and CT-INTEM increase simultaneously more than 300.
本研究的目的。在肝移植术中维持麻醉期间，实现止血的最佳纠正仍是未解决的问题之一。现代凝血监测方法（血栓弹力图、血栓弹力测定法）有助于区分出血增加的原因。迄今为止，尚未根据这些方法制定出明确的血液成分输注标准。本研究的目的是确定肝移植术中止血障碍纠正的标准。
本研究纳入了2009年1月至2010年12月在我院接受肝移植的所有患者。在特定时间间隔采集血样进行止血研究，包括凝血图、凝血因子测定和天然抗凝剂活性测定。
标准凝血试验结果与血栓弹力测定法之间无显著相关性。基于国际止血纠正建议，借助ROC分析寻找血栓弹力测定数据，这些数据可表明需要进行该治疗。关于凝血因子缺乏（国际标准化比值>2，活化部分凝血活酶时间>1.5），血栓弹力图外部凝血时间（CT-EXTEM）>80的敏感度为17%，特异度为97%；血栓弹力图内部凝血时间（CT-INTEM）>240的敏感度为51%，特异度为96%。使用A10-纤维蛋白原血栓弹力图（A10-FIBTEM）诊断纤维蛋白原缺乏时，A10-FIBTEM<9的敏感度为95%，特异度为63%。CT-EXTEM>80且CT-INTEM增加超过300同时出现时，诊断血小板减少症（血小板计数低于每微升50,000个）的敏感度为96%，特异度为81%。
当CT-EXTEM>80且CT-INTEM>240时提示纠正凝血因子缺乏；当A10-FIBTEM<9时提示低纤维蛋白原血症；当CT-EXTEM>80且CT-INTEM同时增加超过300时提示血小板减少症。
