Effects of continuous infusion of moderate dose tranexamic acid and ulinastatin on fibrinolysis during orthotopic liver transplantation
10.3760/cma.j.issn.0254-1416.2012.01.002
- VernacularTitle:静脉输注中等剂量氨甲环酸和乌司他丁对原位肝移植术患者纤溶功能的影响
- Author:
Yiming LIU
;
Huan ZHANG
- Publication Type:Journal Article
- Keywords:
Tranexamic acid;
Trypsin inhibitors;
Infusions,intravenous;
Fibrinolysis;
Liver transplantation
- From:
Chinese Journal of Anesthesiology
2012;32(1):15-19
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effects of continuous infusion of moderate dose tranexamic acid and ulinastatin on fibrinolysis during orthotopic liver transplantation (OLT).Methods Thirty ASA Ⅲ or Ⅳ patients aged 34-63 yr with a body mass index of 17-37 kg/m2 and end-stage liver disease score 6-34,undergoing OLT,were randomly assigned to one of 3 groups ( n =10 each):group control (group C) ; group tranexamic acid (group T) and group ulinastatin (group U).The patients received continuous infusion of normal saline at 10 ml/h in group C or ulinastatin at 100 000 U/h in group U immediately after tracheal intubation until 120 min after portal vein was declamped,while in group T the patients received a loading dose of tranexamic acid 1 g followed by continuous infusion at 10 mg· kg-1 ·h- 1.Prothrombin time (PT),activated partial thromboplastin time (APTT),international normalized ratio ( INR),fibrinogen (Fg),D-dimers (D-D) and fibrin degradation product (FDP) were measured before induction of anesthesia (baseline),at 120 min after skin incision,30 min after clamping of portal vein (anhepatic phase),30 and 120 min after declamping (neohepatic phase) and at the end of operation.The amount of blood loss and transfusion were recorded.The patients were followed up after operation for hepatic artery and portal vein thrombosis in groups U and T.Results There were no significant differences in PT,APTT,Fg,INR and amount of blood loss and transfusion among the 3 groups.The plasma D-D concentration and percentage of patients with plasma FDP ＞ 20μg/ml were significantly lower in group T than in group C.There were no significant differences in plasma D-D concentration and percentage of patients with plasma FDP ＞ 20 μg/ml between groups U and C.No hepatic artery and portal vein thrombosis was detected after operation in groups T and U.Conclusion Continuous infusion of moderate dose tranexamic acid can inhibit fibrinolysis during OLT,but can not reduce the amount of blood loss.Continuous infusion of ulinastatin ( 100 000 U/h) has no significant effect on fibrinolysis during OLT.
