目的 观察成人经典原位肝移植术中应用不同剂量乌司他丁对凝血和纤溶系统的影响.方法 80例拟行原位肝移植的重度肝硬化患者随机分成四组:乌司他丁1、2、3组(U1、U2、U3组)和对照组(C组),每组20例.在术始分别给予U1、U2、U3组乌司他丁1×104、2×104、4×104 U/kg持续泵入;C组给予等量生理盐水.于术前(T0)、无肝前期60 min(T1)、无肝期20 min(T2)、新肝期20 min(T3)、关腹前30 min(T4)静脉采血,常规实验室检测凝血酶原时间(PT)、活化部分凝血激酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、血小板计数(PLT)、D-二聚体(D-Dimer),同时用Sonoclot凝血及血小板功能分析仪测定激活全血凝固时间(ACT)、凝血速率(CR)及血小板功能(PF)变化,并记录整个术程出血量、输注悬浮红细胞以及新鲜冰冻血浆量.结果与C组相比,U1组的凝血指标、失血输血量未见显著差别(P ＞ 0.05);而U2组的APTT、FIB、D-Dimer、ACT、PF等已经出现了变化的趋势,虽然除T4的FIB外其余指标与C组相比差异无统计学意义(P ＞ 0.05),但其综合作用的结果是显著地减少了术中失血量和输注血液制品量(P ＜ 0.05);U3组作用更为明显,APTT、FIB、D-Dimer、ACT、PF等指标在无肝期和新肝期与C组比较差异有统计学意义(P ＜ 0.05),并进一步减少了术中失血量和输注血液制品量(P ＜ 0.01).结论 乌司他丁呈剂量依赖性改善肝移植无肝期和新肝期的凝血状况,并减少术中失血输血量,其机制主要是抑制纤溶亢进和保护血小板功能,并可能参与维持促凝抑凝的动态平衡.%Objective To investigate the roles of different doses of Ulinastatin oncoagulation function and fibrolysis in classical orthotopic liver transplantation (OLT). Methods Eighty patients with severe hepatic cirrhosis underwent OLT were randomly divided into four groups, Ulinastatin 1, 2, 3 (Ui, U2, U3) and control group, with 20 cases in each group. Different doses of Ulinastatin or saline were continuously pumped since the beginning of operation: group Ul5 lxlO4 U/kg; group U2 , 2xlO4 U/kg; and group U3, 4xl04 U/kg. The same volume of saline was given to the control group (group C). Blood samples were taken for determination of prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), platelet (PLT), D-Dimer and Sonoclot parameters: activated clotting time of whole blood (ACT), clot rate (CR), platelet function (PF) at the time points of preoperation (To), 60 min of preanhepatic stage (T,), 20 min of anhepatic stage (T2), 20 min in neohepatic stage (T3), 30 min before the abdominal closure (T4). Volumes of blood loss, red blood cells infusion, fresh frozen plasma infusion during whole operation process were recorded. Results Coagulation parameters and the volumes of blood loss, red blood cells infusion, fresh frozen plasma infusion of group U[ were no significant difference compared with those of group C (P > 0.05); APTT, FIB, D-Dimer, ACT, PF of group U2 had changed in trends, although the remaining indicators except FIB at T4 were no significant statistical difference compared with the group C (P > 0.05), but the concerted effort significantly reduced intraoperative blood loss and transfusion of blood products (P < 0.05). More significant difference were observed between group U3 and group C: APTT, FIB, D-Dimer, ACT, PF in the anhepatic phase and neohepatic phase of group U3 were different significantly with group C (P < 0.05), and further reducing intraoperative blood loss and transfusion of blood products were recorded in group U3 (P < 0.01). Conclusion Ulinastatin improve coagulation condition and reduce the amount of blood loss and transfusions dose dependantly during anhepatic phase and neohepatic phase of liver transplantation. Inhibition of fibrinolysis, protection of platelet function may be the mechanism andeiiect oi maintaining dynamic balance oi procoagulation and anticoagulation may be involved.
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