老年腰椎手术患者围术期动态血栓弹力图观察

The change of perioperative thrombelastogram in lumbar spine surgery of older patients

目的探讨老年患者腰椎围手术期血栓弹力图(thrombelastogram,TEG)的特点,为老年腰椎手术患者深静脉血栓的预防提供参考。方法 30例纳入本研究的老年腰椎手术患者,分别于术前(手术当天麻醉前T0d)、术后第1天(T1d)、术后第3天(T3d)、术后1周(T1w)、术后2周(T2w)清晨空腹静脉采血行TEG普通检测。结果 T0d组血栓弹力图正常,T1d、T3d、T1w和T2w分别与T0d比较:反应时间(R)和凝固时间(K)缩短,凝固角(Angle)增大,差异有统计学意义(P<0.05或P<0.01),最大血块强度(MA)及凝血块强度(G)变化不明显。T1d、T3d、T1w和T2w组间比较,差异无统计学意义(P>0.05)。结论观察组的血栓弹力图在术前未见异常,术后均呈现高凝状态,凝血因子活性及纤维蛋白原功能均增强,且术后1周左右高凝状态达到峰值,所以,要积极预防在此期间血栓形成。

Objective To observe the change of perioperative thrombelastogram（TEG） in elderly patients with lumbar spine surgery, and provide reference for deep vein thrombosis prevention in elderly patients with lumbar spine surgery.Methods Thirty elderly patients with lumbar spine surgery were enrolled into the study. Fasting venous blood samples were collected during preoperative（the day of surgery before anesthesia, T0d）、postoperative day 1（T1d）、postoperative day 3（T3d）、postoperative week 1（T1w）、postoperative week 2（T2w）.The thrombelastogram（TEG） was measured for all blood samples. Results The thrombelastogram of T0 d group was normal.The reaction time（R） and clotting time（K） of T1 d, T3 d, T1 w and T2 w were shortened,and the coagulation angle（Angle） increased with significant difference when compared with T0d（P〈 0.05 or P〈 0.01）, the largest clot strength（MA） and clot strength（G） did not change significantly. The difference of MA between T1 d, T3 d, T1 w and T2 w group, was not significant（P〉 0.05）. Conclusion The thrombelastograms of the observation group is normal in the preoperative period, but and the postoperative period presents a hypercoagulable state, The activity and functions of fibrinogen clotting factors are enhanced. Hypercoagulable state reach its peak level at about 1 week after surgery, so we must actively prevent thrombosis during this period.