肝移植术中旋转血栓弹性描记术或常规凝血试验与出血的关系：一项观察性探索性研究。

Association between intraoperative rotational thromboelastometry or conventional coagulation tests and bleeding in liver transplantation: an observational exploratory study.

机构信息

Department of Anaesthesiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada; Critical Care Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada.

Critical Care Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada; Department of Anaesthesiology, Institut de Cardiologie de Montréal, Montréal, Canada.

出版信息

Anaesth Crit Care Pain Med. 2020 Dec;39(6):765-770. doi: 10.1016/j.accpm.2020.07.018. Epub 2020 Oct 1.

DOI:10.1016/j.accpm.2020.07.018

PMID:33011332

Abstract

INTRODUCTION

Liver transplantation is associated with major blood loss and transfusions. Our objective was to evaluate the association between coagulation results (rotational thromboelastometry (ROTEM) and conventional coagulation tests) and intraoperative bleeding or perioperative red blood cell (RBC) transfusions in liver transplantation.

METHODS

We measured ROTEM values and conventional coagulation tests at the beginning of surgery, after graft reperfusion and at the end of surgery. We did bivariate correlation and multivariable regression analyses to explore the association between test results and either intraoperative bleeding or perioperative RBC transfusions.

RESULTS

We enrolled 75 consecutive patients. Median [Q1-Q3] intraoperative blood loss was 1400 mL [675-2300] and 59% of patients did not receive any RBC transfusion either intraoperatively or postoperatively. In multivariable analyses, FIBTEM maximal clot firmness (MCF) measured at the beginning of surgery was associated with lower intraoperative blood loss (ß = -106 mL for each mm; 95% CI, -203 to -9 mL). Both a higher haemoglobin concentration (multiplicative factor = 0.89 for each g/L; 95% CI, 0.84 to 0.95) and FIBTEM MCF measured at the end of surgery (multiplicative factor = 0.68 for each mm; 95% CI, 0.48 to 0.95) were associated with fewer postoperative RBC transfusions.

CONCLUSION

FIBTEM MCF was strongly associated with intraoperative blood loss and postoperative transfusions while other coagulation results were not. This study might inform future clinical trials on ROTEM-based interventions in liver transplantation.

STUDY REGISTRATION

Clinical Trials.gov: NCT02356068.

摘要

简介

肝移植会导致大量失血和输血。我们的目的是评估凝血结果（旋转血栓弹性测定法（ROTEM）和常规凝血试验）与肝移植术中出血或围手术期红细胞（RBC）输血之间的关系。

方法

我们在手术开始时、移植再灌注后和手术结束时测量 ROTEM 值和常规凝血试验。我们进行了双变量相关性和多变量回归分析，以探讨测试结果与术中出血或围手术期 RBC 输血之间的关系。

结果

我们纳入了 75 例连续患者。术中失血量中位数[Q1-Q3]为 1400ml[675-2300]，59%的患者术中或术后均未输注 RBC。在多变量分析中，手术开始时 FIBTEM 最大凝块硬度（MCF）与术中出血量减少相关（每增加 1 毫米减少 106ml；95%CI，-203 至-9ml）。血红蛋白浓度较高（每增加 1g/L 的倍数因子为 0.89；95%CI，0.84 至 0.95）和手术结束时 FIBTEM MCF（倍数因子为 0.68 每增加 1 毫米）与术后 RBC 输注减少相关。