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李宏  李津源  杜洪印 翁亦齐  秦煦  邓封

Effects of preoperative Recombinant Factor VIIa on blood coagulation in patients undergoing Liver Transplantation   Li Hong  Li Jinyuan  Du Hongyin ，et al. Department of Anesthesia, <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />Tianjin First Central Hospital,Tianjin 300192,China

[Abstract] Objective  To evaluate the effects of preoperative Recombinant Factor VIIa on intraoperative blood coagulation in patients undergoing Liver Transplantation. Method  20 patients of end-stage liver disease were selected, who needed to perform the liver transplantation .They were classified as Child- Pugh’s score B or C and ASA II or III. Their prothrombin time (PT) was beyond 20s and their Hb was（51~114）g.L-1 before the operation.The rFVIIa was administered as a single bolus injection (dose range,40~80μg.kg-1 ) , 5 min before skin incision . PT、prothrombin activity(PTA)、activated partial thromboplastin time(APTT)、thrombin time(TT)、international normalized ratio(INR)、fibrinogen(Fib)、D-Dimer(DD)、platelet(PLT) count(PLTc) were measured from the blood of right jugular vein in seven time point: the time prior to injection (T0)、5 min (T1)、15min(T2)、30min（T3）、60min（T4）、120min（T5）after the injection、15 min during the anhepatic period (T6) and  30 min after the reperfusion（T7）. Result  Compared to T0 , there was no significant difference in the hemodynamic changes (P > 0.05) .PT decreased significantly from T1 to T6 and reached its bottom(15.8±2.9s) in T2 (P<0.05);INR had the same trend with PT(P<0.05); PTA increased remarkably from T1 to T6 and reached its maximum amplitude (73±24％) in T2(P<0.05), then it reached to the level of T0　in the period of reperfusion(p>0.05); APTT decreased  from T2 to T5 and reached its minimal value(69±32s) in T3(P<0.05), APTT reached the value of 88±51s(P>0.05) during anhepatic period, but it was still lower than the amplitude of T0 and recovered to the amplitude of T0  in the period of reperfusion(P>0.05). TT  increased only in T7(P < 0.05).It was founded that there was not any statistically significant difference in Fib、PLTc、DD in every time point (P>0.05). Red blood cells (RBC) (11±6)u was transfused and the blood loss was（600～4000）ml during the operation. After the application of rFVIIa, the blood loss was（200～2400）ml in 120 minutes. No hypersensitivity reaction and postoperative thromboembolic event was observed in this study. Conclusion  The application of  preoperative rFVIIa can improve the intraoperative blood coagulation function in the patients undergoning liver transplantation, and it is possible to reduce intraoperative blood loss and transfusion requirements.

[key words] Factor Ⅶa； Liver Transplantation；Blood Coagulation Tests