Starczewska Małgorzata H, Giercuszkiewicz Dorota, Niewiński Grzegorz, Kański Andrzej
2nd Department of Anaesthesia and Intensive Care, Central Teaching Hospital, Medical University of Warsaw, Poland.
Anaesthesiol Intensive Ther. 2016;48(1):34-40. doi: 10.5603/AIT.a2015.0020. Epub 2015 Apr 1.
Liver transplantation (LT) remains one of the most challenging surgical procedures. For many years uncontrolled bleeding and catastrophic haemorrhages were one of the major causes of perioperative mortality and morbidity. During the past fifty years or so, significant progress in surgical techniques and perioperative management has led to a marked change in transfusion practice over time, where up to 79.6% of LTs in experienced transplant centers are performed without any blood product transfusion. Despite this, perioperative bleeding and transfusion requirements remain potent predictors of patient's mortality, as well as postoperative complications and graft survival. The major impact of blood product transfusion on LT recipient outcomes implies that all patients on waiting lists should be carefully screened for the presence of risk factors of perioperative bleeding. Although multiple predictors of transfusion requirements during LT have been identified, no predictive model validated across centers has been constructed. The most suitable strategies to reduce intraoperative blood loss in this group should be employed on a case-to-case basis. This paper aims to summarize the most up-to-date evidence in the management of haemostasis in LT recipients.
肝移植（LT）仍然是最具挑战性的外科手术之一。多年来，术中无法控制的出血和灾难性大出血一直是围手术期死亡率和发病率的主要原因之一。在过去五十多年里，手术技术和围手术期管理取得了显著进展，随着时间的推移，输血实践发生了显著变化，在经验丰富的移植中心，高达79.6%的肝移植手术无需输注任何血液制品。尽管如此，围手术期出血和输血需求仍然是患者死亡率、术后并发症及移植物存活的有力预测指标。血液制品输注对肝移植受者结局的重大影响意味着，应对所有等待名单上的患者进行仔细筛查，以确定其是否存在围手术期出血的危险因素。尽管已经确定了肝移植术中输血需求的多个预测指标，但尚未构建一个在各中心均得到验证的预测模型。对于该群体，应根据具体情况采用最合适的策略来减少术中失血。本文旨在总结肝移植受者止血管理方面的最新证据。
