使用旋转血栓弹力图评估术前白蛋白置换液血浆置换疗法对接受ABO血型不相容活体供肾移植患者血液凝固的影响。

Effects of preoperative plasma exchange therapy with albumin replacement fluid on blood coagulation in patients undergoing ABO-incompatible living-donor kidney transplantation using rotational thromboelastometry.

作者信息

Shirozu Kazuhiro, Fujimura Naoyuki, Karashima Yuji, Ikeda Mizuko, Kitada Hidehisa, Okabe Yasuhiro, Kurihara Kei, Henzan Tomoko, Hoka Sumio

机构信息

Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

Department of Anesthesiology, St. Mary's Hospital, Kurume, Japan.

出版信息

BMC Anesthesiol. 2018 Jun 19;18(1):68. doi: 10.1186/s12871-018-0536-2.

DOI:10.1186/s12871-018-0536-2

PMID:29921231

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6008919/

Abstract

BACKGROUND

ABO-incompatible living-donor kidney transplantation (LDKT) requires immunotherapy and plasma exchange therapy (PEX). PEX with albumin replacement fluid reportedly decreases fibrinogen levels. However, no reports have described the effects of PEX with albumin replacement fluid on blood coagulation parameters and blood loss during the perioperative period. Therefore, we investigated the effects of preoperative PEX on blood coagulation parameters and blood loss during the perioperative period in patients undergoing ABO-incompatible LDKT as measured by rotational thromboelastometry (ROTEM®).

METHODS

Twenty-eight patients undergoing LDKT were divided into the PEX group (ABO incompatible with PEX, n = 13) and non-PEX group (ABO compatible without PEX, n = 15). ROTEM® parameters, standard laboratory test parameters, bleeding volume, and transfusion volume were compared between PEX and non-PEX group. MCE, which represents platelet contribution to clot strength and where "MCE" stands for maximum clot elasticity, was calculated from the difference in MCE between EXTEM and FIBTEM.

RESULTS

The bleeding volume during surgery and the intensive care unit (ICU) stay was significantly higher in the PEX than non-PEX group (p < 0.01). Maximum clot firmness (MCF) of EXTEM (MCF), MCF, and MCE was significantly lower in the PEX than non-PEX group (p < 0.01). In the PEX group, the bleeding volume during surgery was very strongly correlated with the baseline MCF and MCE, and the bleeding volume during the ICU stay was strongly correlated with the postoperative MCF and MCE.

CONCLUSIONS

These results suggest that the increased blood loss in the PEX group during surgery and the ICU stay was associated with decreased platelet contribution to clot strength as measured by ROTEM®.

TRIAL REGISTRATION

UMIN-Clinical Trial Registry UMIN000018355 . Registered 21 July 2015.

摘要

背景

ABO血型不相容的活体供肾肾移植（LDKT）需要免疫治疗和血浆置换疗法（PEX）。据报道，使用白蛋白置换液进行血浆置换会降低纤维蛋白原水平。然而，尚无报告描述使用白蛋白置换液进行血浆置换对围手术期凝血参数和失血的影响。因此，我们通过旋转血栓弹力图（ROTEM®）研究了术前血浆置换对ABO血型不相容的LDKT患者围手术期凝血参数和失血的影响。

方法

28例接受LDKT的患者分为血浆置换组（ABO血型不相容且接受血浆置换，n = 13）和非血浆置换组（ABO血型相容且未接受血浆置换，n = 15）。比较血浆置换组和非血浆置换组的ROTEM®参数、标准实验室检查参数、出血量和输血量。MCE通过EXTEM和FIBTEM之间的MCE差值计算得出，代表血小板对血凝块强度的贡献，其中“MCE”代表最大血凝块弹性。

结果

血浆置换组手术期间和重症监护病房（ICU）住院期间的出血量显著高于非血浆置换组（p < 0.01）。血浆置换组EXTEM的最大血凝块硬度（MCF）、MCF和MCE显著低于非血浆置换组（p < 0.01）。在血浆置换组中，手术期间的出血量与基线MCF和MCE密切相关，ICU住院期间的出血量与术后MCF和MCE密切相关。