ObjectiveTo evaluate the changes in thrombelastography(TEG) during orthotopic liver transplantation （OLT） in Chinese. MethodsTwentyfive patients with cirrhosis of liver undergoing OLT were studied. They were composed of two groups: cirrhosis group （n=15） and liver neoplasm group （n=10）. Anesthesia was induced with propofol 1.5-2 mg/kg,fentanyl 3-5 μg/kg and vecuronium 0.1 mg/kg and maintained with isoflurane or enflurane inhalation.The operation was divided into three phases: ① before operation and preanhepatic phase （120 min after operation was started）, ② 30 min after liver was removed,③ 5 min before reperfusion and 5 min,15 min,30 min,60 min and 120 min after reperfusion.In 8 patients among the 25 patients heparinasecelite TEG was measured 5 min after reperfusion in addition to celite TEG.If there was significant differences in traces between the two TEG measurements,an intravenous bolus of 50-75 mg protamine was given and the heparinasecelite TEG was repeated.The measured variables included the r （reaction） time,representing the rate of initial fibrin formation K （coagulation） time, alpha angles （α） reflecting fibrinplatelet interaction, MA （maximal amplitude） indicating qualitative platelet function and percent fibrinolysis at 60 min. ResultsIn cirrhosis group changes in TEG occurred after liver was removed and in earlier period after reperfusion, while in liver neoplasm group changes in TEG were found in earlier period after reperfusion as compared with preoperative value.At 5 min after reperfusion there were significant differences in TEG （r，K，α and MA） values between celite and heparincelite TEG （P＜0.01）. ConclusionDuring OLT coagulation disorder occurs mainly at anhepatic and early reperfusion phase.
肝脏移植作为终末期肝病的治疗，自上个世纪80年代在欧美国家获得公认以来，已在世界各国得到迅速开展。我国自90年代后期以来，在全国掀起了第二个肝移植的热潮，迄今已完成1 000余例肝移植，在围手术期处理、手术技术、介入放射、移植免疫、抗感染治疗等各个方面均获得丰富的经验，我国肝移植的效果及长期生存率亦逐步赶上国际先进水平。总的来讲，适合进行肝移植的病种可分为良性及恶性肝病，鉴于恶性肝病行肝移植后复发率高，长期生存率低，因而其作为肝移植的指征长期以来存在争议，而良性终末期肝病则是肝移植的主要指征。我院自1999年2月以来连续施行肝移植114例，其中良性肝病为69例，占60.5%。本文仅针对良性肝病肝移植的一些特点谈谈我们的经验和体会。
Objective To study the effects of total saponins of panax notoginseseng injection on the coagulation function in sepsis. Methods 50 sepsis patients with normal coagulation function were randomly divided into two groups. 25 patients in the control group received the routine treatment and the other 25 patients in the treatment group received total saponins of panax notoginseseng injection additionally. The levels of Plt, PT, TT, APTT, FIB and D-D were measured before the therapy and on 1st, 3rd and 7th day after the therapy. Results The levels of Plt, PT, TT, APTT, FIB and D-D before the therapy had no significant differences between the two groups ( P gt; 0. 05) . The levels of Plt and FIB had significant differences between the two groups on 7th day after therapy ( P lt;0. 01, P lt; 0. 05) . PT, TT, and APTT were prolonged in the controlled group gradually, butwere not prolonged or even shortened in the treatment group,which were significantly shorter in the treatment group on 7th day after therapy ( P lt; 0. 05) . D-D slightly elevated in the control group, but slightly elevated at first and dropped gradually in the treatment group, which was significantly lower in the treatment group on7th day after therapy. Conclusion Total saponins of panax notoginseseng injection has a protective effect on coagulation function in sepsis.
目的 分析反复发作的抗凝血类灭鼠药所致获得性凝血功能障碍的临床特点，探讨其诊治方案。方法 对2009年3月－2010年12月收治的3例抗凝血类灭鼠药所致获得性凝血功能障碍患者的临床表现、实验室检查和治疗转归进行分析，并复习相关文献。 结果 3例患者均以同时出现多部位出血为首发表现，经应用维生素K1、凝血酶原复合物、新鲜冰冻血浆、冷沉淀等治疗，患者病情好转，实验室指标恢复正常。停药（2、5周，3个月）后再次出现多部位出血，再给予维生素K1等治疗，病情可缓解。 结论 维生素K1可作为首选的治疗药物，且对反复发作的患者同样有效。为避免再发性出血，应维持治疗至少3个月。
目的:探讨脑损伤患者凝血功能水平与颅脑损伤伤情转归的相关性。方法:收集70例颅脑损伤患者的临床资料,伤者抽取静脉血2 mL,进行凝血功能检测,分析结果与临床资料等分别采用SPSS 11.5软件进行χ2检验和logistic回归分析。结果:在13例凝血功能异常患者中有5例(38%)伤情加重(较入院时脑内血肿体积增大,迟发性血肿等),明显高于凝血功能正常而伤情加重者(12%,Plt;0.05);单因素和多因素logistic回归分析提示凝血功能异常时脑损伤伤情加重的危险因素。结论:脑创伤后凝血功能异常时颅脑损伤患者伤情加重的危险因素。
目的 探讨脂多糖（LPS）、白细胞介素-6（IL-6）和血小板活化因子（PAF）与重症胸腹创伤后凝血功能紊乱发生的相关性及可能的致病机理。方法 收集2009年1月至2011年12月期间在中国人民解放军第二五三医院急诊科就诊、创伤指数≥17分且除外合并颅脑损伤及在急诊科内死亡的胸腹创伤患者62例，在予以抢救、治疗的同时抽血检查血小板计数（PLT）、血浆D-二聚体（D-D）、部分活化凝血酶原时间（APTT）、凝血酶原时间（PT）、LPS、IL-6和PAF，并对其结果进行相关性分析。结果 本组患者就诊时检测的PLT为（157.73±78.11）×109/L， D-D为（1 023.88±208.72） U/L，APTT为（46.95±17.85） s，PT为（19.44±6.95） s，TT为（58.27±12.44）s，除PLT降低外，其余4项指标均升高或延长； LPS为（322.85±104.54） U/L，IL-6为（285.51±81.46） ng/mL，PAF为 （14 714.70±4 427.95） ng/L， 三者均升高； PLT与LPS、IL-6和PAF之间呈负相关关系（P＜0.001），而D-D、APTT、PT和TT与LPS、IL-6和PAF之间均呈正相关关系（P＜0.001）。结论 LPS、IL-6及PAF可能参与了重症胸腹创伤后凝血功能障碍的发生；重症胸腹损伤后出现的微循环障碍及内毒素血症是凝血功能障碍发生的重要机理。针对LPS、IL-6和PAF进行早期干预，有可能改善重症胸腹创伤患者的凝血功能障碍。
目的 比较进展性慢性肝病及重症肝炎患者原位肝移植(OLT)围手术期凝血功能的变化。方法 回顾性分析我中心2004年1月至2005年12月期间行OLT治疗进展性慢性肝病及重症肝炎患者各37例的围手术期血小板(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(FIB)的变化。结果 2组患者除术前PT、APTT,术后第5 d PLT、FIB和术后第7 d FIB的差异有统计学意义外（plt;0.05），其余时段2组患者的PLT、PT、APTT及FIB 间差异均无统计学意义（Pgt;0.05）, 提示重症肝炎患者凝血功能损害更为严重； OLT术后，2组患者的凝血功能均逐渐恢复正常, 但并非完全同步。结论 进展性慢性肝病与重症肝炎患者OLT围手术期凝血功能变化显著，应注意监测及处理，但术后2组间各指标间比较差异并不明显。