肝移植期间的床旁止血监测可减少输血需求并改善患者预后。

Point-of-care haemostasis monitoring during liver transplantation reduces transfusion requirements and improves patient outcome.

作者信息

Leon-Justel Antonio, Noval-Padillo Jose A, Alvarez-Rios Ana I, Mellado Patricia, Gomez-Bravo Miguel A, Álamo Jose M, Porras Manuel, Barrero Lydia, Hinojosa Rafael, Carmona Magdalena, Vilches-Arenas Angel, Guerrero Juan M

机构信息

Laboratory Medicine Department, Huelva University Hospital (Institute of Biomedicine of Seville, Seville University), Spain.

Laboratory Medicine Department, Virgen del Rocío University Hospital, Seville (Institute of Biomedicine of Seville, Seville University), Spain.

出版信息

Clin Chim Acta. 2015 Jun 15;446:277-83. doi: 10.1016/j.cca.2015.04.022. Epub 2015 Apr 25.

DOI:10.1016/j.cca.2015.04.022

PMID:25916692

Abstract

BACKGROUND

Optimal haemostasis management can improve patient outcomes and reduce blood loss and transfusion volume in orthotopic-liver-transplant (OLT).

METHODS

We performed a prospective study including 200 consecutive OLTs. The first 100 patients were treated according to the clinic's standards and the next 100 patients were treated using the new point-of-care (POC)-based haemostasis management strategy. Transfusion parameters and other outcomes were compared between groups.

RESULTS

Transfusion requirements were reduced in the POC group. The median and IQR of red-blood-cells (RBC) transfusion units were reduced from 5 [2-8] to 3 [0-5] (p < 0.001), plasma from 2 [0-4] to 0 (p < 0.001), and platelets from 1 [0-4] to 0 [0-1] (p < 0.001), into the POC group only four patients received tranexamic acid and fibrinogen transfusion rate was 1.13 ± 1.44 g (p = 0.001). We also improved the incidence of transfusion avoidance, 5% vs. 24% (p < 0.001) and reduced the incidence of massive transfusion (defined as the transfusion of more than 10 RBC units), 13% vs. 2% (p = 0.005). We also observed a relationship between RBC transfusion requirements and preoperative haemoglobin, and between platelet transfusion and preoperative fibrinogen levels. The incidence of postoperative complications, such as, reoperation for bleeding, acute-kidney-failure or haemodynamic instability was significantly lower (13.0% vs. 5%, p = 0.048, 17% vs. 2%, p < 0.001, and 29% vs. 16%, p = 0.028). Overall, blood product transfusion was associated with increased risk of postoperative complications.

CONCLUSIONS

A haemostatic therapy algorithm based on POC monitoring reduced transfusion and improved outcome in OLT.

摘要

背景

优化止血管理可改善原位肝移植（OLT）患者的预后，并减少失血和输血量。

方法

我们进行了一项前瞻性研究，纳入200例连续的OLT患者。前100例患者按照临床标准治疗，后100例患者采用基于即时检验（POC）的新止血管理策略进行治疗。比较两组之间的输血参数和其他预后指标。

结果

POC组的输血需求减少。红细胞（RBC）输注单位的中位数和四分位数间距从5[2 - 8]降至3[0 - 5]（p < 0.001），血浆从2[0 - 4]降至0（p < 0.001），血小板从1[0 - 4]降至0[0 - 1]（p < 0.001），POC组仅4例患者接受了氨甲环酸治疗，纤维蛋白原输注率为1.13±1.44 g（p = 0.001）。我们还提高了避免输血的发生率，从5%提高到24%（p < 0.001），并降低了大量输血（定义为输注超过10个RBC单位）的发生率，从13%降至2%（p = 0.005）。我们还观察到RBC输血需求与术前血红蛋白之间以及血小板输血与术前纤维蛋白原水平之间存在关联。术后并发症的发生率，如因出血、急性肾衰竭或血流动力学不稳定而再次手术的发生率显著降低（分别为13.0%对5%，p = 0.048；17%对2%，p < 0.001；29%对16%，p = 0.028）。总体而言，血液制品输血与术后并发症风险增加相关。