간이식술 중 혈액 재관류 전후에 발생한 헤파린효과의 변화 및 이들이 수혈량에 미치는 효과

Background: One of the difficulties we have in the management of anesthesia for the optimal liver transplantation is involved in coagulopathy. The purpose of this paper is to observe and investigate the variation of the heparin effects occurred before and after the fulfillment of reperfusion done in terms of native thromboelastogram (nTEG) or heparinase-guided Thromboelastogram (hgTEG). Methods: In 134 patients who had a living related liver transplantation, by grouping them into four according to the presence or the absence of heparin effects, we are to observethe effects on the quantity of transfusion which each group shows and clinical variables like CTP score, UNOS classification, PT, and preoperative platelet count. Results: It is found that 54 out of 134 patients (40.3%) had heparin effects before the reperfusion, while 101 (75.4%) had the effects after the reperfusion to the grafted liver. It is showed that there was no significant difference in a comparison between groups involved with packed red blood cell transfused, fresh frozen plasma, platelet concentrates, fluid by RIS. In the comparison between groups involved in clinical factors, it is disclosed that although there was no significant difference in four factors, that is, CTP score, UNOS classification, PT, and preoperative platelet count. Conclusions: We can confirm that the occurrence of heparin effect after reperfusion is remarkably increasing compared to that of heparin effect before reperfusion. Also, it can be reported that heparin effects can occur frequently during liver transplantation, but they have no direct relation to transfusion. (Korean J Anesthesiol 2007; 52: 422~9)