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이병욱 인제대학교 1995 仁濟醫學 Vol.16 No.2
정상 지혈기전, 지혈작용에 있어서의 간의 역할, 간질환 환자의 비정상적 지혈 원인 및 동소성 간이식 수술의 지혈장애에 관하여 고찰하고, 지혈장애에 대하여 간편하고 신속정확한 진단을 내릴 수 있게 해주며, 지혈장애의 치료에 역동적으로 도움을 주는 혈전탄성묘사도(Thrombelastogram, TEG)에 대하여 논의하고자 한다. Hemostasis is a complex process that prevents or terminates blood loss from a disrupted intravascular process, provides a fibrin network for tissue repair, and ultimately, removes the fibrin when it is no longer needed. Also, hemostasis involves the interrelationships among all elements involved in hemostatic process. In the management of clinically significant hemostatic problems, it is desirable that transfusion therapy should be a specific component therapy given as small amount as possible, if necessary. Still, for the diverse hemostatic problems, conventional coagulation studies are insufficient as monitoring system and there is lack of adequate management guidelines. Thrombelastogram(TEG) continuously measures the shear elasticity of a whole blood from the time when the first fibrin strands are formed to the completion of the clot formation, including fibrinolysis. It provides a more valuable monitoring system for hemostasis in the clinical arena than do the analytic assays of individual hemostatic factors. So, review is presented on the biological hemostasls, role of the liver in hemostasis, abnormal hemostasis in liver disease, and hemostatic problems in orthotopic liver transplantation, throughout which the most diverse and the severeest hemostatic problems have ever been encountered in the field of clinical medicine. The clinical applicability of TEG as a monitoring system for hemostasis, and the clinical effectiveness of dynamic TEG-guided replacement therapy for the hemostatic problems is also described.
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