血栓弹力图用于门静脉高压脾切除术中自体血回输的监测

Thrombelastogram monitoring in autologous blood transfusion during splenectomy in the treatment of portalhy pertension

目的应用血栓弹力图(thromboelastogram,TEG)监测门静脉高压症(portal hypertension,PHT)患者行脾切除术中应用血液回输期间凝血功能的变化规律。方法对13例PHT患者进行术前、术后常规凝血功能指标及TEG测定。术前发现异常者予以相应的血液制品及治疗。常规凝血功能指标包括血小板计数(PLT)、血浆凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、TEG参数包括反应时间R值、K值、α角及最大振幅MA。对手术前后的检查结果进行比较。结果患者术前术后PT、APTT明显缩短,PLT明显增加,TEG参数中R值明显缩短、K值下降、α角增大、MA没有显著变化,患者凝血状态较术前明显改善。结论 TEG对判断PHT患者脾切除术中行血液回输时的凝血功能变化有重要意义,可指导围手术期的血液保护。

Objective To assess the role of thromboelastography（ TEG） in monitoring coagulation changes of autologous transfusion during splenectomy for portal hypertension（ PHT） and its significance for blood protection. Methods Routine coagulation tests and TEG were completed during the surgeries. Blood products were used and relevant treatments were undertaken when abnormal results were found preoperatively. Routine coagulation tests included platelet count（ PLT）,prothrombin time（ PT） and activated partial thromboplastin time（ APTT）. TEG indexes included reaction time（ R）,K value,α angle and maximum amplitude（ MA）. Then conventional coagulation indexes were compared with TEG indexes respectively.Results Thirteen PHT patients undergoing splenectomy and receiving autotransfusion were enrolled. Compared with preoperative,PT and APTT were significantly decreased,PLT was significantly increased,while reaction time and K value were significantly decreased,α angle was increased,and MA remained unchanged in the postoperative period. Conclusions TEG can be a monitor of coagulation preoperatively and a guidance for blood protection in autotransfusion during splenectomy for PHT.