The Effect Of The Heparin And The The Application Of Protamin During Liver Transplantation

Objective To investigate the change of plasma heparin activity using Xa Factor Inhibitory Assay and activated clotting time(ACT) during liver transplantation. Methods Venous blood samples were drawn from 25 patients undergoing liver transplantation at different time points(before skin incision, 5 min before opening of superior vena cava, 5min, 1h, 2h and 3h after opening of the superior vena cava), and the plasma heparin activity was detected using Xa Factor Inhibitory Assay. At the same time ACT were measured. Results The mean of plasma heparin activity was 0.41, 0.42, 0.96, 0.70, 0.44, and 0.42 IU·mL^-1 respectfully. The plasma heparin concentration was the highest(0.96 IU·mL^-1 at 5 min after opening of the superior vena cava(P<0.05). The plasma heparin activities at T₄ declined but were still higher than that at T₁, T₂, T₅, and T₆(P<0.05). There was no difference between T₁ T₂, T₅ and T₆. ACT was 158.8, 147.1, 250.6, 215.0, 169.9 and 164.7 s respectfully. ACT was the longest(250.6 s) at 5 min after opening of the superior vena cava(P<0.05). ACT was shortened at T₄ but was still longer than that at T₁, T₂, T₅, and T₆(P<0.05). There was no difference between T₁, T₂, T₅ and T₆ (P>0.05). Conclusion The plasma heparin activity and ACT increased rapidly after the opening of superior vena cava, and decreased 2 hours later. There was a relationship between ACT and heparin activity. Objective To investigate the effect of different doses of protamine on blood coagulation after reperfusion during liver transplantation. Methods Thirty patients with liver diseases (17 males, 13 females) weighting 52.8-76.3 kg undergoing liver transplantation were randomly divided into 4 groups according to the doses of protamine used: groupâ… 0 mg·mg^-1 (n=7); groupâ…¡0.4mg·mg^-1(n=8); groupâ…¢0.6mg·mg^-1(n=7) and group IV 0.8mg·mg^-1 (n=8).Anesthesia was induced with propoful, fentanyl and rocuronium and maintained with isoflurane inhalation and intermittent i.v. boluses of fentanyl. Body temperature was maintained at 35.1-37.2℃and Hct at 22%-35%. Different doses of protamine were given to the patients when the superior vena cava was opened. Blood samples was taken from central vein at different points(before incision of the skin, 5 min after opening of superior vena cava, 10min,1h, 2h and 3h after using of protamine) (T_1-6, and the plasma heparin activity was detected using X a Factor Inhibitory Assay. At the same time ACT were measured. At the end of operation , The blood loss and the usage of blood components and coagulant and anti-fibrinolytic drugs were recorded. Results The four groups were comparable with respect to age, body weight, ASA physical status and Child classification. The activated coagulation time (ACT) was significantly shortened and the heparin concentration was decreased in groupâ…¢and groupâ…£as compared to that in groupâ… and groupâ…¡(P<0.05). There was no difference of ACT and heparin activity between groupâ… and groupâ…¡(P>0.05), and there was no difference of ACT and heparin activity between groupâ…¢and groupâ…£(P> 0.05), too. There was no significant difference in the requirements and loss of blood and liquid, coagulant and anti-fibrinolytic drugs such as lycophilized human prothrombin complex concentrates, fibrinogen, fresh frozen plasma, and cryoprecipiation(P>0.05).Clonclusion Protamine 0.6mg·mg^-1 was sufficient to remove the effect of heparin during reperfusion in liver transplantation.