Schumacher Carsten, Eismann Hendrik, Sieg Lion, Friedrich Lars, Scheinichen Dirk, Vondran Florian W R, Johanning Kai
From the Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
Exp Clin Transplant. 2019 Apr;17(2):222-230. doi: 10.6002/ect.2017.0236. Epub 2018 Oct 5.
Increased transfusion requirements in liver transplantation have been reported to be associated with worsened outcomes, more frequent reinterventions, and higher expenses. Anesthesiologists might counteract this through improved coagulation management. We evaluated the effects of rotational thromboelastometry on transfusion and coagulation product requirements and on outcome measurements.
Patients who were 14 years or older and who were undergoing liver transplant at Hannover Medical School between January 2005 and December 2009 were included in this retrospective analysis. Demographic, clinical, and laboratory data, use of rotational thromboelastometry, intraoperative need for blood or coagulation products and antifibrinolytic substances, and clinical course were recorded. Correlations were examined using appropriate statistical tests.
Our study included 413 patients. Use of rotational thromboelastometry was associated with less frequent intraoperative administration of red blood cell concentrates, fresh frozen plasma, platelet concentrates, prothrombin complex concentrates, and antithrombin concentrates (all P < .05). In addition, univariate and multivariate tests showed that rotational thromboelastometry was correlated with decreased need for red blood cell concentrates and fresh frozen plasma (all P < .05). Intraoperative administration rates of antifibrinolytic substances and fibrinogen concentrate were significantly increased in patients who received rotational thromboelastometry monitoring (both P < .05). However, use of rotational thromboelastometry was not associated with massive transfusion rates (> 10 units vs less), clinical outcome, or length of stay in the intensive care unit (all P > .05).
Use of rotational thromboelastometry during liver transplant may reduce the need for intraoperative transfusion and coagulation products. Relevant effects of rotational thromboelastometry on patient outcomes or lengths of stay in the intensive care unit could not be ascertained. However, readjustment of therapeutic thresholds may improve the clinical impact.
据报道，肝移植中输血需求增加与预后恶化、再次干预更频繁及费用更高有关。麻醉医生可通过改善凝血管理来应对这一情况。我们评估了旋转血栓弹力图对输血及凝血制品需求以及对预后指标的影响。
本回顾性分析纳入了2005年1月至2009年12月在汉诺威医学院接受肝移植且年龄在14岁及以上的患者。记录了人口统计学、临床和实验室数据、旋转血栓弹力图的使用情况、术中对血液或凝血制品及抗纤溶物质的需求以及临床病程。使用适当的统计检验来检查相关性。
我们的研究纳入了413例患者。旋转血栓弹力图的使用与术中较少频繁输注红细胞浓缩液、新鲜冰冻血浆、血小板浓缩液、凝血酶原复合物浓缩液和抗凝血酶浓缩液相关（所有P <.05）。此外，单因素和多因素检验表明，旋转血栓弹力图与红细胞浓缩液和新鲜冰冻血浆需求减少相关（所有P <.05）。接受旋转血栓弹力图监测的患者术中抗纤溶物质和纤维蛋白原浓缩液的给药率显著增加（两者P <.05）。然而，旋转血栓弹力图的使用与大量输血率（> 10单位与≤10单位）、临床结局或重症监护病房住院时间无关（所有P >.05）。
肝移植期间使用旋转血栓弹力图可能减少术中输血及凝血制品的需求。旋转血栓弹力图对患者结局或重症监护病房住院时间的相关影响尚无法确定。然而，调整治疗阈值可能会改善临床效果。
