Changes Of Coagulation And Fibrinolysis Function During Perioperative Period Of Hepatectomy

Objective:To investigate the changes of coagulation and fibrinolytic system after hepatectomy,and the causes and significance of the decrease of postoperative fibrinogen,by comparing the routine coagulation and fibrinolysis indexes and specific molecular markers before and after hepatectomy.Methods:75 patients who underwent hepatectomy and met the inclusion and exclusion criteria in the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Kunming Medical University from September 1,2019 to November 31,2020 were randomly selected.The general condition,operation methods and reason,operation time,intraoperative hepatic port occlusion time,blood loss,blood product transfusion,use of transamic acid and total hospital stay and other clinical data of all patients were recorded.The blood samples were collected at T0(before surgery),T1(after surgery)and T2(24 hours after surgery),send them to the laboratory for routine blood test(Hb,PLT)and coagulation function(PT,APTT,FIB,FDP,DD,ATⅢ).Collected the the venous blood samples again at T1&T2,centrifuged(4℃,2000 revolution/min)to obtain the upper serum.F1+2,PLA,PAP,PAI-1 were determined by ELISA.75 patients were divided into TXA group(53 cases)and non-TXA group(22 cases),then 75 patients were divided into low FIB group(FIB<2g/L)and normal FIB group according to the FIB level at T1。The data were statistically analyzed by SPSS26.0.Results:1.Changes of coagulation function after hepatectomy:Hb,PLT,AT-Ⅲ and FIB at T1 were significantly lower than T0,the difference was statistically significant(P<0.001).Hb,AT-Ⅲ and FIB at T2 were slightly increased,but the difference was still statistically significant(P<0.001).PLT at T2 showed a continuous downward trend,and the difference was statistically significant(P<0.001).PT and APTT continued to increase after operation,reaching a high value at T2,and the difference was statistically significant compared with T0(P<0.001).FDP and DD increased at T1,the difference was statistically significant compared with T0(P<0.05),T2 review reached a high value,the difference was statistically significant compared with T0 and T1(P<0.001).2.The FDP and DD of patients in the tranexamic acid group at T1 were lower,and the difference was statistically significant(P<0.001).The intraoperative blood loss was more,and the difference was statistically significant(P<0.05).3.Comparison of general data of patients in different FIB after operation:the intraoperative blood loss,24-hour postoperative peritoneal drainage and perioperative blood infusion in low FIB group were larger,and the differences were statistically significant(P<0.05).4.Comparison of groups:The FIB of the low FIB group was significantly lower than normal group at T0,and the difference was statistically significant(P<0.001).The PT and APTT were longer in low FIB group at T1,while AT-Ⅲ is lower than normal group,and the difference was statistically significant(P<0.05).PLT and FIB were also significantly lower than normal group(P<0.001).The differences in other indicators were not statistically significant.5.The patients with lower preoperative FIB level,the higher Child-Pugh classification of liver function,the greater the amount of bleeding,the shorter the time of hepatic portal occlusion,the greater the possibility of postoperative low FIB.Conclusions:1.Hepatectomy is often accompanied by varying degrees of coagulation and fibrinolytic system activation.2.Early prophylactic use of tranexamic acid is necessary for large hepatectomy to reduce intraoperative bleeding.3.Patients with decreased FIB after hepatectomy have lower preoperative FIB level,higher Child-Pugh classification of liver function,more intraoperative blood loss and postoperative drainage,and larger amount of perioperative transfusion of blood products.Therefore,we should strengthen the monitoring and treatment of perioperative fibrinogen level.4.By combining specific coagulation,fibrinolytic molecular markers and traditional laboratory markers,it’s helpful for us to manage coagulation dysfunction after hepatectomy.