关键词: 肝移植, 血栓弹力图, 凝血功能指标, 输血

Abstract: Objective The aim of this study was to investigate the dynamic changes of thromboelastography (TEG) and coagulation function parameters before and after liver transplantation and its significance for guidance of blood transfusion. Methods 52 patients with benign and malignant liver diseases underwent liver transplantation between March 2018 and March 2020, and the TEG indexes, such as reaction time (R), clot formation time (k), angle (α), maximum amplitude (MA) and four items of coagulation functions such as prothrombin time (PT), activated partial thrombin time (APTT), thrombin time (TT) and fibrinogen (FIB) were monitored in patients at pre-without liver, without liver and new liver stages. Results Out of our 52 recipients of liver transplantation, 17.3%, 86.5% and 75.0%(P<0.05) of them received blood transfusion at pre-without liver, without liver and new liver stage; the APTT in patients with blood transfusion at pre-without liver stage was(74.4±7.2) s, significantly longer than 【(66.9±8.1)s, P<0.05】 in patients without blood transfusion, the PT and TT in recipients with blood transfusion at new liver stage were(30.4±5.4)s and (30.2±3.6)s, significantly longer than 【(26.1±4.6)s and (27.0±4.2)s, P<0.05 in those without blood transfusion, while the APTT, PT, TT and Fib in patients with or without blood transfusion at without liver stage were not much different(P>0.05); the K value in patients with bloodtransfusion at without liver stage was (7.6±1.8)min, significantly longer than 【(6.0±2.0)min, P<0.05】 in those without blood transfusion, the R, K andα in patients with blood transfusion at without liver stage were(26.4±5.5)min, (15.3±2.8)min and (15.8±4.4)°, while they were(21.8±4.3)min, (12.0±3.9)min and (19.5±3.9)°, respectively,in those without blood transfusion, showing significantly different between the two groups(P<0.05); the α and MA in patients with blood transfusion at new liver stage were(20.3±4.1)° and (34.4±5.8)mm, significantly different compared to(23.8±3.5)° and (39.0±4.5)mm in patients without blood transfusion(P<0.05); the APTT in 20 patients with huge blood transfusion at pre-without liver stage was(77.3±6.8)s, significantly longer than【(70.4±7.9)s, P<0.05】 in 32 patients without huge blood transfusion, the K in patients with huge blood transfusion at pre-without liver stage was (8.0±1.7)min, significantly longer than 【(7.1±1.4)min, P<0.05】 in those without huge blood transfusion, the R in patients with huge blood transfusion at without liver stage was (29.3±5.2)min, significantly longer than 【(23.6±4.7)min, P<0.05】 in those without huge blood transfusion, the K in patients with huge blood transfusion atwithout liver stage was (16.8±3.1)min, much longer than【(13.7±2.8)min, P<0.05】in those without huge blood transfusion, the α at without liver stage was (15.2±3.6)°, significantly smaller than【(18.4±4.4)°, P<0.05】 in those without huge blood transfusion, the TT in patients with huge blood transfusion at new liver stage was(31.5±3.0)s, significantly longer than 【(28.2±3.3)s, P<0.05】 in those without huge blood transfusion, the MA at new liver stage was(32.8±5.5)mm, significantly shorter than 【(38.7±4.3)mm, P<0.05】 in those without huge blood transfusion, and theα at new liver stage was (19.8±3.7)°, significantly smaller than【(22.4±3.1)°, P<0.05】 in patients without huge blood transfusion. Conclusion The dynamic surveillance of four items of coagulation functions and TEG parameters are helpful to judge the coagulation function state andcould guide the clinicians for appropriate blood transfusion before and after liver transplantation, especially the dynamic monitoring of R and α values of TEG are helpful to predict the risk of massive blood transfusion during operation.

Key words: Liver transplantation, Thromboelastogram, Coagulation functions, Blood transfusion