血栓弹力图对肝素抗凝患者血液成分输注指导初探

Value of thromboelastograph in guiding blood components transfusion in patients with heparin

目的探讨血栓弹力图(TEG)对肝素抗凝患者血液成分输注的指导作用。方法对300例接受肝素抗凝治疗患者应用传统凝血项检测进行筛选,87例入选本研究。对入选患者进行枸橼酸化高岭土激活样品血栓弹力图检测(CK-TEG)和枸橼酸化高岭土激活样品肝素酶杯对比检测(CKH-TEG),对两种TEG检测参数进行比较,并对两种检测方法所提示需要输注的血液成分的种类及用量进行比较。结果两种血栓弹力图检测参数R、K、Angle、CI差异均有统计学意义(P<0.05),所提示的血浆和血小板需要输注量差异有统计学意义(P<0.05)。结论 CKH-TEG能够排除肝素抗凝患者体内残留肝素对凝血功能的干扰,准确反映患者真实的凝血功能,对肝素抗凝患者进行血液成分输注治疗具有指导意义。

Objective To investigate the value of thromboelastograph in guiding blood components transfusion in patients with heparin anticoagulantion therapy. Methods Three hundred patients with heparin anticoagulantion therapy were selected to measure conventional coagulation tests. Patients with coagulopathy were selected as research subjects. Cit-rated kaolin-activated samples thrombelastometry （CK-TEG） and citrated kaolin-activated samples thrombelastometry tests in heparins cup （CKH-TEG） were measured respectively for the research subjects. The parameters between CK-TEG and CKH-TEG were compared, and the need of blood components transfusion before and after the heparins cup neutralization were compared. Results The result of TEG tests showed that the values of R、K、Angle and CI were significantly different between CK-TEG and CKH-TEG tests （P〈 0.05）, and there was significant difference in the need of plasma and platelet transfusion before and after heparins cup neutralization （P〈 0.05）. Conclusion Since the interference of heparin to an-ti-coagulation tests could be excluded, the thromboelastography test can accurately reflect the true coagulation status of patient, and guide the blood components transfusion in patients with heparin therapy.