简单的手术内得分,包括血栓等度参数,可以预测肝移植后出血的早期重新手术
Patricia Duque1,2, Teresa Sagredo1,2, Patricia Piñeiro1,2
1Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid.
概括
粘弹性测试 (VEA) 有效地预测肝移植 (LT) 后出血的早期重新手术. 使用VEA和输血数据的新风险评分可以识别高风险患者,可能改善结果.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植手术 移植手术
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
背景情况:
- 肝移植后出血的早期再手术 (ERBALT) 是一种严重并发症,患病率和死亡率很高.
- 目前,没有可靠的预测工具可以识别ERBALT风险患者.
- 这项研究旨在评估传统的凝血试验 (CCT) 和粘弹性试验 (VEA) 对ERBALT的预测能力.
研究的目的:
- 评估CCT和VEA的预测准确性,以识别需要在肝移植 (LT) 后出血早期重新手术的患者.
- 根据粘弹性测定结果和其他外科手术期间因素,开发ERBALT的预测得分.
主要方法:
- 一项前性观察性研究,涉及222名接受LT治疗的患者.
- 使用CCT和VEA在四个关键时间点测量凝血参数:诱导后,无肝阶段结束,再输血后10分钟和60分钟.
- 使用多变量逻辑回归模型,开发了结合VEA结果和手术内输血产品输血数据的预测得分.
主要成果:
- 在222名患者中,有25名 (11.26%) 需要ERBALT.
- 需要ERBALT的患者患有更严重的肝病 (更高的Child-Pugh得分),并获得更多的液体和血液制品.
- 结合R60-CTINTEM,R60-CTEXTEM和手术内红细胞输血的预测得分有效地分层化了风险,得分为7表明ERBALT的风险为47.8%,而得分≤3.3的风险为1%.
结论:
- 粘弹性测定 (VEA) 证明了肝移植后出血早期重新手术的显著预测价值.
- 开发的风险评分,利用VEA参数,可以帮助及时识别ERBALT的高风险患者.
- 实施这种评分可以促进主动凝血管理,并可能改善LT后的结果.
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