Gerlach H, Rossaint R, Bechstein W O, Blumhardt G, Neuhaus P, Falke K
Clinic for Anesthesiology & Intensive Care Medicine, University Clinic Rudolf Virchow, Free University of Berlin, Germany.
Semin Thromb Hemost. 1993;19(3):282-5. doi: 10.1055/s-2007-994041.
Complications in patients undergoing OLT, such as hemorrhagic events, are caused not only by surgical problems but also by the profound functional disturbances arising from hepatic insufficiency, which are at least partially cured by the procedure itself. Preoperative clotting data give insight only into the dysfunction of the explanted organ. Hence, we tried to perform a standardized, "goal-directed" anesthesiologic management in the perioperative phase in OLT, following strict indications for blood replacement according to diuresis, hemoglobin level, and hemodynamic parameters. We performed 200 OLTs in 185 patients, according to usual methods. The mean intraoperative fluid requirement was 884 ml of balanced salt solution, 8.1 units of RBC, and 9.4 units of FFP. During the first 24 hours postoperatively, an average of 2.4 units of RBC and 5.6 units of FFP had to be transfused. Currently, 170 of the 185 patients (91.9%) are alive and well. Our data demonstrate that a distinct reduction of transfusion rates in OLT is possible, neglecting clotting data and improving clotting function by avoiding hemodilution.
接受肝移植手术的患者出现的并发症，如出血事件，不仅由手术问题引起，还由肝功能不全导致的严重功能紊乱引起，而手术本身至少能部分治愈这些紊乱。术前凝血数据仅能反映被切除器官的功能障碍。因此，我们试图在肝移植手术的围手术期进行标准化的“目标导向”麻醉管理，根据尿量、血红蛋白水平和血流动力学参数严格掌握输血指征。我们按照常规方法对185例患者进行了200次肝移植手术。术中平均液体需求量为884毫升平衡盐溶液、8.1单位红细胞和9.4单位新鲜冰冻血浆。术后24小时内，平均需要输注2.4单位红细胞和5.6单位新鲜冰冻血浆。目前，185例患者中有170例（91.9%）存活且状况良好。我们的数据表明，在肝移植手术中不考虑凝血数据并通过避免血液稀释改善凝血功能，有可能显著降低输血率。
