ABSTRACT
Objective To investigate the effect of thromboelastography (TEG) in guiding clinical transfusion in liver cirrhosis patients during operation.Methods Sixty liver cirrhosis patients who underwent liver resection under general anesthesia from April 5,2015 to October 30,2016 were selected in this study.Among them,there were male in 46 cases and female in 14 cases,ASA physical status Ⅱ or Ⅲ,Child-Pugh grade B or C.According to coagulation function,the patients were divided into thrombelastogram analysis group (group TEG,n =30) and empirical treatment group (group control,n =30).The coagulation time (R),the formation time (K),the maximum amplitude of thrombosis (Ma) and solidification angle (alpha value) were observed and recorded.According to the analysis results,choice type and quantity of infused blood was chosen.Results The bleeding volume in group TEG and blood transfusion (including suspended red blood cells,fresh frozen plasma,cryoprecipitate,platelet) were significantly reduced,compared with the group control (P＜0.05);the bleeding volume of 12,24 h in group TEG was significantly lower than that in group control (P＜0.05).Conclusion Thromboelastography can monitor the real-time blood coagulation function in patients,guide the perioperative blood transfusion and reduce the input of blood products during the surgery and postoperative abdominal bleeding occurrence,which has important application value in resection of liver cirrhosis in patients with liver cancer.
ABSTRACT
Objective To observe the effects of dexmedetomidine on the perioperative stress response and immunologic function in hepatectomy patients with hepatitis cirrhosis.Methods Forty patients(Child-Pugh A or B),ASA Ⅱ or Ⅲ with hepatitis cirrhosis undergoing hepatectomy were randomly divided into dexmedetomidine group(group D)and control group(group C)with 20 cases in each.Patients in group D were administered 0.5 μg/kg bolus dose of dexmedetomidine over 10 min, followed by 0.4 μg·kg-1 ·h-1 infusion until closing abdomen.And patients in group C were given normal saline by the same way as in group D.Flow cytometry was used to detect peripheral blood T lymphocytes (CD3 + ,CD4 + ,CD8 + ,CD4 +/CD8 + ),NK cells at 30 min before anesthesia(T0 ),imme-diately(T1 ),24 h(T2 )and 48 h(T3 )after surgery.Enzyme-linked immunosorbent assay was used to detect the levels of inflammatory cytokines concentration(IL-2,IL-10)at T0-T3 and stress hormones (Cor,ACTH,ALD)at T0 ,T2 and T3 .The levels of SBP,DBP and CVP at T0 ,immediately with intu-bation(Ta ),T1 and extubation(Tb ).Results Compared to those at T0 ,the levels of CD3 + ,CD4 + , CD8 + ,CD4 +/CD8 + at T1 and T2 were significantly lower in both groups(P <0.05),and the levels in group D were obviously higher than those in group C(P <0.05).The levels in group D were back to preoperative levels at T3 ,but the levels in group C were still lower than those at T0 (P <0.05).The levels of NK cells were higher at T1 in both groups,and the levels in group D was significantly higher than those in group C(P <0.05).Compared to those at group D,the concentration of IL-2 was lower at T1 and T2 ,the concentration of IL-10 was higher at T2 and T3 in group C (P <0.05).The levels of Cor,ALD,ACTH at T2 and T3 were significantly higher than those at T0 in both groups,but those in group D were markedly lower than those in group C (P < 0.05 ).The SBP,DBP and CVP of two groups was no statistically significant difference at T0 ,and SBP,DBP and CVP of the group D at Ta , T1 ,Tb was lower than that of T0 and group C (P <0.05).Conclusion Patients with hepatitis cirrho-sis underwent general anesthesia has certain immune suppression after liver cancer surgery,and con-tinuous intravenous infusion of dexmedetomidine during anesthesia may suppress the perioperative stress reaction effectively and alleviate the inhibition of immunologic function.