ĐÁNH GIÁ SỰ THAY ĐỔI MỘT SỐ CHỈ SỐ ĐÔNG MÁU ĐO BẰNG ROTEM Ở BỆNH NHÂN NGƯỜI LỚN ĐƯỢC GHÉP GAN

Abstract

Objectives: To evaluate the changes of some coagulation indexes and the coagulation disorders in liver transplant surgery as well as the correlation between the basic coagulation indexes and the ROTEM values. Methods: Descriptive study on 34 patients getting liver transplantation. The patient had coagulation blood test and ROTEM test at 6 time points: After induction stage of anesthesia (To); the end of the dissection phase (T1); the end of the anhepatic (no liver) phase (T2); after reperfusion (5 min after release of the venous anastomosis) (T3); new liver phase (T4), and the first day of postimplantation (T5). During surgery, the patient received blood products transfusion according to the protocol of Viet Duc hospital. The test results are compared with the reference range of the test laboratory and compared with the To point index. The basic coagulation indexes was analyzed and correlated with the corresponding index on ROTEM test. Results: Hypocoagulation was very common in liver recipients, especially in the reperfusion phase (prolonged APTT in 76.5%, fibrinogen reduction in 79.4% and thrombocytopenia in 76.5%. in 91.2% of patients) and new liver stage (prolonged PT was seen in 35.3%). However, the coagulation indexes tended to return to normal value on the first day after transplantation. There is a strong correlation between the basic coagulation indexes and the ROTEM indexes: PT with CT- EXTEM (r: 0.394); aPTT with CT- INTEM (r: 0.61); Platelet count with A10 – EXTEM (r: 0.819); fibrinogen concentration with MCF - EXTEM (r: 0.631). Conclusions: Patients receiving liver often experience hypocoagulation disorders during the reperfusion phase and the new liver phase. ROTEM values have a strong correlation with the basic coagulation indexes, which can help to make treatment decisions earlier.