Objective To investigate the causes of coagulation dysfunction in orthotopic liver transplantation by observing the results of thrombelastography（TEG） heparinase test. Methods There were 24 cases of patients undergoing orthotopic liver transplantation, including 20 males and 4 females. The age of included patients was 41 ~ 60 years old， and weight was 48 ~ 86 kg. All cases received orthotopic liver transplantation without bypass. The total amount of red blood cells and plasma used in the operation were recorded. The central venous blood sample was collected at the 15th min in the new liver stage and tested by the TEG analyzer. The blood samples were added to the TEG heparinase test cup and TEG normal test cup. If the two kinds of TEG did not coincide and the difference was significant， the protamine was given， and then the TEG tests were repeated. Results All the patients received a stable operation. At the 15th min in the new liver stage， the R， K，αangle and MA in TEG heparinase test cup group were significant difference compared to the normal test cup group（P ＜ 0.05）. After the protamine was given, results of tests suggested that there was no significant difference between the TEG heparinase test cup group and TEG normal test cup group in R， K，αangle and MA（P ＞ 0.05） Conclusion The anticoagulant effect of heparin is th e main factor of early coagulation dysfunction in new liver stage.

目的 通过观察血栓弹力图（TEG）肝素酶对比检测的变化，探讨原位肝移植术中凝血功能 障碍的原因。方法 接受原位肝移植手术患者 24 例，男性 20 例，女性 4 例，年龄 41 ～ 60 岁，体重 48 ～ 86 kg ；美国麻醉医师协会（ASA）Ⅱ～Ⅳ级。所有病例均采取经典非转流术式。记录患者手术过程中所用 红细胞以及血浆输注总量，分别于新肝期 15 分钟采集中心静脉血样，将血液样本同时加入 TEG 肝素酶试 杯和 TEG 普通试杯中，应用 TEG 分析仪进行检测，观察两种不同试杯的检测结果。如果两组 TEG 图形不 重合且差异明显，则给予鱼精蛋白，在此之后重复 TEG 检测。结果 所有患者手术过程均顺利，新肝期 15 分钟时，与普通试杯组结果相比，含有肝素酶试杯组的 R 值、K 值、α 角及 MA 值均差异有统计学意义 （P ＜ 0.05）。鱼精蛋白静注后重复 TEG 检测结果显示，普通试杯组与肝素酶试杯组的 R 值、K 值、α 角及 MA 值相比，差异无显著的统计学意义（P ＞ 0.05）。结论 肝素的抗凝作用是新肝再灌注早期凝血功能紊 乱的主要因素。