Abstract:

Objective To investigate the observation and management of blood coagulation function inpatients with severe hepatitis during perioperative period of liver transplantation. Methods The blood coagulation functions of 39 patients with severe hepatitis who underwent allogeneic liver transplantation in our hospital fromJanuary 2018 to March 2021 were retrospectively analyzed. Blood coagulation markers, such as thrombin time（PT），prothrombin time activity（PTA），international standardized ratio（INR），platelet count（PLT），thrombin time（TT）， fibrinogen（FIB）and activated partial thromboplastin time（APTT）, were measured before transplantation（T0），3 hours after transplantation（T1），24 hours after operation（T2）and 72 hours after operation（T3）. The dosage of clotting substance，operation time，volume of blood loss and volume of blood products during liver transplantationwere recorded. Results Compared with preoperative values，the values of PT and APTT decreased gradually afterthe use of coagulant substances（P ＜ 0.05），and returned to normal 72 hours after operation. The values of PTA and FIB gradually increased into the normal range after the use of coagulant substances（P ＜ 0.05）. Conclusion Thecoagulation function of the patients with severe hepatitis is poor，and the operation time of livertransplantation islong and complicated. It is of great significance to closely observe the bleeding of the patients，monitor the bloodcoagulation function and supplement the corresponding coagulation substances in time to ensure the smooth progress of the operation. 

Key words:

Severe hepatitis , Liver transplantation , Perioperative period , Blood coagulation management

摘要：

目的 探讨重症肝炎患者在肝移植围术期的凝血功能变化的观察及管理。方法 回顾性分析 2018 年 1 月至 2021 年 3 月因重症肝炎收治本院接受同种异体肝移植手术的 39 例肝移植受者的临床资料，分别在术前（T0）、移植后 3 h（T1）、术后 24 h（T2）、术后 72 h（T3）几个时间段，检测凝血酶时间（prothrombin time，PT）、凝血酶原时间活动度（prothrombin time activity，PTA）、国际标准化比值（internationalnormalized ratio，INR）、血小板计数（platelet count，PLT）、凝血酶时间（thrombin time，TT）、纤维蛋白原 （fibrinogen，FIB）、活化部分凝血活酶时间（activated partial thromboplastin time，APTT）等指标。并记录肝 移植术中凝血物质用量、手术时间、出血量及血液制品用量。结果 相比于术前，凝血物质使用后，PT 值及 APTT 值逐渐下降（P ＜ 0.05），术后 72 h 恢复正常。相较于术前，使用凝血物质后，PTA 值和 FIB 值逐渐上升至正常范围（P ＜ 0.05）。结论 重症肝炎患者凝血功能差，肝移植手术时间长而复杂，术中密切观 察患者出血情况，监测凝血功能，及时补充相应的凝血物质以保证手术顺利进行有重要意义。

关键词:

重症肝炎 ；肝移植 ；围术期 ；凝血功能管理 ,