Sirikonda P R, Spillert C R, Koneru B, Ponnudurai R, Wilson D J, Lazaro E J
Department of Surgery, UMDNJ-New Jersey Medical School, Newark 07103-2714, USA.
J Natl Med Assoc. 1996 May;88(5):306-9.
It is believed that perioperative hemorrhage, in the hepatoportal area, results from a coagulopathy. This study determined if this could be quantitated by a modified recalcification time (MRT) test developed in our laboratory. Unlike prothrombin (PT) and activated partial thromboplastin times (APTT), the MRT is performed with whole blood to ensure the role of blood cells and chemicals (particularly tissue factor, a potent procoagulant) in the coagulation process. Candidates for liver transplantation (n = 11) were studied. Samples (5 mL) of citrated venous blood were obtained from the patients. Aliquots (1 mL) from these samples were divided into groups of vials labeled C, S, and E. Groups C and S received 20 microL saline and group E, 20 microL of saline containing 10 micrograms of Escherichia coli endotoxin (055: B5W). Vial C was incubated for 10 minutes and vials S and E for 120 minutes, all at 37 degrees C. Then, the MRT was determined on 300 microL of blood from each vial after adding 40 microL of 0.1M calcium chloride. Mean MRT values (minutes +/- standard deviation) for C (MRTC), for S (MRTS), and for E (MRTE) were compared with like values from healthy controls (n = 29). Despite prolonged PT and APTT values, MRT values were shortened in patients with cirrhosis. This hypercoagulability detected by the MRT exonerates a hemorrhagic coagulopathy and possibly implicates widened and thinned gaps in the walls of the portal venous tributaries as the cause of perioperative hemorrhage.
据信，肝门区围手术期出血是由凝血功能障碍引起的。本研究旨在确定能否通过我们实验室开发的改良复钙时间（MRT）试验对其进行量化。与凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）不同，MRT试验采用全血进行，以确保血细胞和化学物质（特别是组织因子，一种强效促凝剂）在凝血过程中的作用。对11例肝移植候选者进行了研究。从患者身上采集5 mL枸橼酸盐抗凝静脉血样本。将这些样本中的1 mL等份分成标记为C、S和E的小瓶组。C组和S组接受20 μL生理盐水，E组接受20 μL含10 μg大肠杆菌内毒素（055:B5W）的生理盐水。将小瓶C在37℃孵育10分钟，小瓶S和E孵育120分钟。然后，在每个小瓶中加入40 μL 0.1M氯化钙后，对300 μL血液测定MRT。将C组（MRTC）、S组（MRTS）和E组（MRTE）的平均MRT值（分钟±标准差）与健康对照者（n = 29）的类似值进行比较。尽管肝硬化患者的PT和APTT值延长，但MRT值缩短。MRT检测到的这种高凝状态排除了出血性凝血功能障碍的可能性，并可能暗示门静脉分支壁上增宽变薄的间隙是围手术期出血的原因。
