快速血栓弹力图对冠状动脉旁路移植术患者围术期大量输血的预测价值

Rapid thrombelastography predicts perioperative massive blood transfusion in patients undergoing coronary artery bypass grafting

目的:研究快速血栓弹力图(r-TEG)检查在预测冠状动脉旁路移植术(CABG)患者围术期大量输血(MBT)中的作用。方法:收集2015年3月至2017年11月在武汉大学中南医院接受首次CABG的患者共120例,术前均做r-TEG检查;术中MBT接受至少4 U红细胞(1 U红细胞来自400 mL全血),术后24 h MBT接受至少5 U红细胞。结果:术中MBT患者平均术前血红蛋白(Hb)为119.1 g/L,非MBT患者为131.0 g/L。术中MBT患者平均体外循环(CPB)为115.0 min,非MBT患者为96.6 min。术前较低的Hb(P=0.001)和较长的CPB(P=0.001)是术中MBT的独立危险因素。当Hb<110 g/L时,MBT发生率急剧上升至50.0%;当CPB≥120 min时,MBT发生率快速上升至38.5%。术后24 h MBT患者中位活化凝血时间(ACT)为128.0 s,非MBT患者为105.0 s。术后24h MBT患者中位自体输血(ABT)为250 mL,非MBT患者为500 mL。术后24 h MBT患者平均年龄为64.8岁,非MBT患者为60.7岁。较长的ACT(P<0.001)、较少的自体输血(P=0.001)和年龄较大(P=0.008)是术后24 h内发生MBT的独立危险因素。当ACT≥150 s时60%的患者接受了MBT;当ABT≥400 mL时,MBT发生率急剧下降至8.1%;70岁以上患者MBT发生率上升至50.0%。结论:术前r-TEG ACT可预测CABG术后的MBT。我们建议使用r-TEG仔细监测凝血系统,这样甚至可以在手术开始前快速诊断凝血异常。

Objective:To identify the effect of rapid thrombotomography(r-TEG)in predicting massive blood transfusion(MBT)for patients undergoing coronary artery bypass grafting(CABG).Methods:A total of 120 patients first time undergoing CABG at Zhongnan Hospital of Wuhan University between March 2015 and November 2017 were included.All patients had done r-TEG tests before surgery.Patients with MBT received at least 4 units of RBCs intra-operatively or 5 units RBCs post-operatively(1 unit RBC from 400 mL whole blood).Results:The average preoperative hemoglobin(Hb)of patients with intraoperative MBT was 119.1 g/L,and that of patients without MBT was131.0 g/L.The average CPB time of patients with intraoperative MBT was 115.0 min,and that of patients without MBT was 96.6 min.Lower preoperative Hb(P=0.001)and longer CPB time(P=0.001)were independent risk factors for MBT during surgery.MBT incidence increased sharply to50.0%when Hb<110 g/L,and to 38.5%when CPB time≥120 min.The median activated clotting time(ACT)of patients with postoperative MBT was 128.0 s,and that of patients without MBT was 105.0 s.The median ABT of patients with postoperative MBT was 250 mL,and that of patients without MBT was 500 mL.The average age of patients with postoperative MBT was 64.8 years old,and that of patients without MBT was 60.7 years old.Longer ACT(P<0.001),less autologous blood transfusion(ABT)(P=0.001)and older age(P=0.008)were the independent risk factors for MBT within 24 hours of surgery.Among patients with ACT≥150 s,60%received MBT.The MBT decreased sharply to 8.1%when ABT exceeded 400 mL,and increased sharply to 50.0%among patients≥70 years old.Conclusion:Preoperative r-TEG ACT can predict the increase of postoperative MBT in patients undergoing CABG.We recommend the careful monitoring of coagulation system with r-TEG,which allows rapid diagnosis of coagulation abnormalities even before the start of surgery.