Hackl W, Zadrobilek E, Mauritz W, Längle F, Höcker P, Sporn P
Intensivebehandlungestation I, Klinik für Anaesthesie und Allgemeine Intensivmedizin der Universität Wien.
Anaesthesist. 1989 Oct;38(10):539-43.
Seventy-two consecutive patients undergoing orthotopic liver transplantation at the Department of Surgery I, University of Vienna Medical School (OLT nos. 1 to 72), were evaluated. Their mean age was 47 years (range: 18-63 years). The indications for liver transplantation are listed in Table 1. All transplant procedures were performed without using a bypass technique. The intraoperative management and surgical procedure have been described elsewhere [7]. Patients were categorized in two groups, each of which was divided in two subgroups. Group I consisted of 18 patients transplanted before the introduction of preoperative plasma exchange. These were retrospectively allocated to two subgroups on basis of their preoperative prothrombin times (PT): A (n = 9): preoperative PT less than 40%; B (n = 9): preoperative PT greater than 40%. The two subgroups of group 2, which contained 54 patients, were compared on a prospective basis: C (n = 32): preoperative PT above 40%; D (n = 22): PT on admission below 40%, preoperative plasma exchange. Comparison of the two subgroups was based on the following parameters: (1) pre-exchange PT (subgroup D); (2) preoperative PT (= PT post-plasma exchange in subgroup D; (3) intraoperative infusion volumes (balanced electrolyte solutions and human albumin to maintain an intravascular colloid osmotic pressure greater than 16 mm Hg); (4) transfusion volumes (whole blood stored for no more than 72 h or packed red cells and fresh plasma, as available; and (5) intraoperative sodium bicarbonate requirements to maintain an arterial pH greater than 7.20.
(Table 2) . Prothrombin time (PT): Group 1: Patients in subgroup A had a mean preoperative PT of 34% (range: 15%-40%). This was significantly lower than in subgroup B (74%; 52%-100%; P less than 0.001). Group 2: The pre-exchange mean PT in subgroup D was 27% (12%-39%) vs. 68% in subgroup C (45%-104%), the difference being highly significant (P less than 0.0001). In patients in subgroup D a mean plasma volume of 3638 ml was exchanged by plasmapheresis. This resulted in a significant increase in PT to 55% (Table 3). As a result, the preoperative post-exchange PT in subgroup D was slightly but significantly (P less than 0.005) less than in subgroup C. Transfusion volumes: Group 1: Patients in subgroup A needed significantly more blood units than those in subgroup B (55.3 units [19-110] vs. 18.7 [3-33]).(ABSTRACT TRUNCATED AT 400 WORDS)
对维也纳医科大学第一外科接受原位肝移植的72例连续患者（OLT编号1至72）进行了评估。他们的平均年龄为47岁（范围：18 - 63岁）。肝移植的适应证列于表1。所有移植手术均未使用体外循环技术。术中管理和手术过程已在其他地方描述[7]。患者分为两组，每组再分为两个亚组。第一组由18例在术前血浆置换引入之前接受移植的患者组成。根据他们术前的凝血酶原时间（PT）将这些患者回顾性地分为两个亚组：A组（n = 9）：术前PT小于40%；B组（n = 9）：术前PT大于40%。第二组包含54例患者，其两个亚组进行前瞻性比较：C组（n = 32）：术前PT高于40%；D组（n = 22）：入院时PT低于40%，术前进行血浆置换。两个亚组的比较基于以下参数：（1）置换前PT（D亚组）；（2）术前PT（= D亚组血浆置换后的PT）；（3）术中输液量（平衡电解质溶液和人白蛋白，以维持血管内胶体渗透压大于16 mmHg）；（4）输血量（储存不超过72小时的全血或可用的浓缩红细胞和新鲜血浆）；（5）术中维持动脉pH大于7.20所需的碳酸氢钠量。
（表2）。凝血酶原时间（PT）：第一组：A亚组患者术前平均PT为34%（范围：15% - 40%）。这显著低于B亚组（74%；52% - 100%；P小于0.001）。第二组：D亚组置换前平均PT为27%（12% - 39%），而C亚组为68%（45% - 104%），差异非常显著（P小于0.0
