血栓弹力图在胃癌患者围手术期监测中的意义

Clinical significance of the application of thromboelastogram in the perioperative period of gastric cancer patients

目的:探讨应用血栓弹力图(thromboelastogram,TEG)监测胃癌患者围手术期凝血功能的动态变化及其临床意义。方法:选取2014年3月至2015年5月期间在新乡市中心医院确诊为胃癌并行手术的178例患者为试验组,并按肿瘤不同分期、不同浸润深度及有无淋巴结转移进行分组,对所有手术患者进行术前、术后TEG动态监测,另选取60例健康体检者为正常对照组,行TEG检测,通过对比分析其围手术期凝血功能变化。结果:实验组术前、术后与对照组比较,其TEG参数R、K值明显减小,Angle、MA、CI值则显著增大,差异具有统计学意义(P<0.05)。实验组患者术前、术后对比K值显著降低;Angle值、MA、CI显著升高(P<0.05)。R、LY30等观测值均无显著变化。肿瘤不同分期、不同浸润深度及有无淋巴结转移的患者相比较,其TEG监测值均有显著性差异。结论:胃癌患者围手术期表现为高凝状态,且与患者肿瘤分期、浸润深度及淋巴结转移呈正相关。动态监测胃癌围手术期TEG可为临床提供有价值的凝血信息,并对提高胃癌手术的安全性和降低术后相关并发症有积极的临床意义。

Objective： To monitor the dynamic changes in coagulation function and assess their clinical significance in patients with gas- tric cancer by using thromboelas to gram （TEG）. Methods： A total of 178 patients with gastric cancer from March 2014 to May 2015 in Xinxiang Central Hospital were selected as the experimental group. The patients were grouped based on different tumor stages, inva- sion depths, and lymph node metastasis. The TEG results of all patients were dynamically monitored before and after operation, and 60 healthy persons were selected as normal control group. Blood coagulation change was analyzed by comparing the TEG test results. Results： Compared with those of the control group, the TEG parameters of the experimental group showed significantly decreased R and K values, as well as significantly increased Angle, CI, and MA values, and the differences were statistically significant （P〈0.05）. In the experimental group, the K values were significantly decreased after operation, whereas Angle, MA, and CI were significantly in- creased （P〈0.05）. No significant changes were observed in R, LY30, and others. TEG values were significantly different in the compari- son of values for tumor patients with different stages, different tumor infiltration degrees, and with or without lymphatic metastasis. Conclusion： Blood hypercoagulability in the perioperative period was observed in patients with gastric cancer and was positively corre- lated with tumor stages, tumor infiltration degrees, and lymphatic metastasis. Dynamic monitoring of gastric cancer perioperative TEG can provide valuable information for clinical treatment, improve the safety of gastric cancer surgery, and reduce postoperative compli- cations associated with active clinical significance.