Lewis J H, Bontempo F A, Awad S A, Kang Y G, Kiss J E, Ragni M V, Spero J A, Starzl T E
Department of Medicine, University of Pittsburgh, Pennsylvania.
Hepatology. 1989 May;9(5):710-4. doi: 10.1002/hep.1840090509.
Six intraoperative blood samples were obtained at intervals from each of 100 individuals undergoing their first liver transplants. The patients fell into the following diagnostic categories: postnecrotic cirrhosis 28, primary biliary cirrhosis 20, sclerosing cholangitis 19, miscellaneous diseases 14, carcinoma/neoplasia 12 and fulminant hepatitis 7. Coagulation factor values in the initial (baseline) blood samples varied by patient diagnosis. In general, all factor levels were reduced except factor VIII:C, which was increased to almost twice normal. The slight intraoperative changes in factors II, VII, IX, X, XI and XII suggested that a steady-state relationship existed between depletion (consumption/bleeding) and repletion (transfusion, transit from extra- to intravascular space), even in the anhepatic state. In contrast, there were rapid and very significant falls in factor VIII and fibrinogen and a less pronounced decrease in factor V, all reaching their nadirs in early to mid-Stage III. The cause of these coagulation changes appears to be activation of the fibrinolytic system.
从100例首次接受肝移植的患者中，每隔一段时间采集6份术中血样。这些患者分为以下诊断类别：坏死性肝硬化28例、原发性胆汁性肝硬化20例、硬化性胆管炎19例、杂病14例、癌/肿瘤12例和暴发性肝炎7例。初始（基线）血样中的凝血因子值因患者诊断而异。一般来说，除因子VIII:C升高至几乎正常水平的两倍外，所有因子水平均降低。因子II、VII、IX、X、XI和XII在术中的轻微变化表明，即使在无肝期，消耗（消耗/出血）和补充（输血、从血管外间隙转移到血管内间隙）之间也存在稳态关系。相比之下，因子VIII和纤维蛋白原迅速且非常显著地下降，因子V下降不太明显，所有这些在III期早期至中期达到最低点。这些凝血变化的原因似乎是纤溶系统的激活。
