Kozek-Langenecker S A, Müller C M, Felfernig M, Zimpfer M
Klinik für Anaesthesie und Allgemeine Intensivmedizin, Universität Wien, Osterreich.
Infusionsther Transfusionsmed. 1995 Oct;22(5):296-300.
Changes in hemostasis during orthotopic liver transplantation (OLT) and an intraoperative bleeding complication requiring massive transfusion are discussed.
The monitoring of hemostasis included bed-sided thromboelastography, measurement of in vitro platelet function with the thrombostat and routine coagulation tests as well as retrospective analysis of coagulation factors.
Changes in hemostasis during OLT were documented as reported previously until reperfusion of the donor organ. Due to an incongruence between the caval veins and massive surgical bleeding, the liver had to be clamped again for reconstruction and perfused with University-of-Wisconsin solution. The second reperfusion was technically uncomplicated. However, the coagulation profile deteriorated dramatically: especially a decrease in platelet function and hyperfibrinolysis led to massive oozing. Successful therapeutical intervention included substitution of packed red blood cells. fresh frozen plasma, platelets. concentrates of hemostatic factors, and aprotinin. The patient was discharged from hospital after 5 weeks with a good liver function and a normal coagulation profile.
During OLT, clinically relevant changes in hemostasis can occur suddenly. Therefore. a close perioperative monitoring of primary and secondary coagulation is mandatory.
讨论了原位肝移植（OLT）过程中止血功能的变化以及术中出现的需要大量输血的出血并发症。
止血功能监测包括床边血栓弹力图检查、使用血栓弹力仪测定体外血小板功能、常规凝血试验以及凝血因子的回顾性分析。
OLT过程中止血功能的变化如先前报道所述，直至供体器官再灌注。由于腔静脉不匹配和大量手术出血，肝脏不得不再次阻断以进行重建，并灌注威斯康星大学保存液。第二次再灌注在技术上没有并发症。然而，凝血指标急剧恶化：尤其是血小板功能下降和纤维蛋白溶解亢进导致大量渗血。成功的治疗干预措施包括输注浓缩红细胞、新鲜冰冻血浆、血小板、凝血因子浓缩物和抑肽酶。患者在5周后出院，肝功能良好，凝血指标正常。
在OLT过程中，止血功能可能突然出现具有临床意义的变化。因此，围手术期对原发性和继发性凝血进行密切监测是必不可少的。
