关键词: 肝移植, 氨甲环酸, 低中心静脉压

Abstract:

AIM: To investigate the effects of tranexamic acid(TXA) combined with low central venous pressure (LCVP)on volume management, cerebral oxygen metabolism and prognosis in patients during orthotopic liver transplantation(OLT). METHODS: Forty-eight patients subject to OLT were randomly divided into 3 groups(n=16):control group(group A);Low central venous pressure(LCVP) group(group V) and tranexamic acid(TXA) combined with controlled low central venous pressure(LCVP) group(group T).The group A was treated as a routine; The CVP was maintained in the range of 3-5 cmH2O by inhaling sevoflurane and intravenous infused nitroglycerin in group V,combined with continuous pumped dopamine at the rate of 2-10 μg·kg-1·min-1, maintaining average arterial pressure (MAP) more than 60 mmHg; The group T was given a load dose of 20 mg/kg tranexamic acid after induction of anesthesia, and 10 mg·kg-1·h-1 infusion performed till to the end of operation, the other treatment was as the same as group L.Blood samples were taken from radial artery and jugular simultaneously for blood gas analysis before operation(T1,baseline),10 min before anhepatic phase(T2),30 min after anhepatic phase(T3),30 min after graft reperfusion(T4),2 h after graft reperfusion(T5),and the end of OLT(T6).Cerebral arterial oxygen content(CaO2),jugular oxygen content(CjvO2),cerebral arterial-venous oxygen content difference(Ca-jvO2),cerebraI oxygen extraction rate(CERO2),and cerebral arterial-venous cerebral lactic acid difference(VADL) were calculated by the Fick formulae and the D-dimer was recorded.We also recorded the whole operation time,anhepatic phase time,ICU residence time, volume of blood loss and transfusion,and urine volume.RESULTS:The level of D-dimer in group C at T3, T4 was significantly higher than T1(P<0.05) , while there was no significant difference at each time point in group V and group T (P>0.05).As compared with group A,CaO2,CjvO2,Ca-jvO2,CERO2 and VADL in group V and group T were nearly not changed at different time pioints(P>0.05);but in the same group,as compared with T1 and T2,the CaO2,CjvO2,Ca-jvO2,CERO2 and SjvO2 in T3,T4 were decreased significantly(P<0.05),while VADL was increased significantly(P<0.05). As compared with group A and group V, the length of hospitalization in group T were decreased significantly (P<0.05).As compared with A group,the volume of blood loss and transfusion in group V and group T were decreased(P<0.05),and the urine increased significantly(P<0.05). CONCLUSION:Tranexamic acid combined with low central venous pressure can be used safely for liver transplantation, maintain normal oxygen metabolism, decrease volume of blood loss and transfusion,increase urine volume during OLT,and accelerate the recovery.

Key words: liver transplantation, tranexamic acid, Low central venous pressure