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Massive haemorrhage in liver transplantation:Consequences,prediction and management

World Journal of Transplantation 2016年第2期6卷 291-305页

作者： Stuart Cleland Carlos Corredor Jia Jia Ye coimbatore srinivas Stuart A Mc Cluskey Department of Anesthesia and Pain Management Toronto General HospitalUniversity Health Network Department of Anesthesia University of Toronto

From its inception the success of liver transplantation has been associated with massive blood loss. Massive transfusion is classically defined as > 10 units of red blood cells within 24 h, but describing transfusion rates over a shorter period of time may reduce the potential for survival bias. Both massive haemorrhage and transfusion are associated with increased risk of mortality and morbidity(need for dialysis/surgical site infection) following liver transplantation although causality is difficult to prove due to the observational design of most trials. The blood loss associated with liver transplantation is multifactorial. Portal hypertension secondary to cirrhosis results in extensive collateral circulation, which can bleed during hepatectomy particular if portal pressures are increased. Avoiding volume loading and maintenance of a low central venous pressure together with the use of vasopressors have been shown to reduce blood loss and transfusion during liver transplantation, but may increase the risk of renal impairment post-operatively. Coagulation defects may be present pre-transplant, but haemostasis is often re-balanced due to a deficit in both proand anti-coagulation factors. Further derangement of haemostasis may develop in the anhepatic and neohepatic phases due to absent hepatic metabolic function, hyperfibrinolysis and platelet sequestration in the donor liver. Point-of-care tests of coagulation such as the viscoelastic tests rotation thromboelastometry/thromboelastometry allow and more accurate and rapid assessment of these derangements in coagulation and guide the use of factor replacement and antifibrinolytics. Transfusion protocols guided by these tests have been shown to reduce transfusion rates compared with conventional coagulation tests, but have not shownimprovements in mortality or morbidity. Pre-operative factors associated with massive transfusion include previous surgery, re-do transplantation, the aetiology and severity of liver disease. Intra-operatively the use of piggy-back tech

关键词： Liver transplantation Massive transfusion Coagulopathy

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吸人前列环素成功治疗由鱼精蛋白诱发的重度肺动脉高压

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麻醉与镇痛 2012年第1期8卷 96-100页

作者： AngelaJerath, FANZCA coimbatore srinivas, FRCA Annette Vegas, FRCPC Stephanie Brister, FRCSC 郭晓光（译）吴珊珊（译） Departments of Anesthesia and Pain Medicine Cardiac Surgery Toronto General Hospital Toronto Ontario Canada

急性肺动脉高压严重威胁生命，是一种继发于鱼精蛋白使用后的罕见反应。体循环低血压合并重度肺动脉高压引起右心衰竭的管理具有挑战性。我们报道了此病例，即在使用多种全身性正性肌力药和血管收缩药都难以治疗冠脉搭桥术中鱼精蛋白引... 详细信息

急性肺动脉高压严重威胁生命，是一种继发于鱼精蛋白使用后的罕见反应。体循环低血压合并重度肺动脉高压引起右心衰竭的管理具有挑战性。我们报道了此病例，即在使用多种全身性正性肌力药和血管收缩药都难以治疗冠脉搭桥术中鱼精蛋白引起的急性肺动脉高压后，进行前列环素吸入治疗，此患者的肺动脉压力在10分钟内由70／37mmHg下降至45／23mmHg。这个病例凸显了雾化吸入前列环素具有选择性地扩张肺血管，且全身性降压效应最小的优点。

关键词：重度肺动脉高压鱼精蛋白前列环素吸入治疗急性肺动脉高压诱发冠脉搭桥术血管收缩药

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