血栓弹力图在隧道式带涤纶套导管血栓栓塞中的作用

Thromboelastograph for the detection of blockage in silicone dual-lumen catheter with a Dacron cuff

目的探讨血栓弹力图在隧道式带涤纶套导管血栓栓塞中的作用。方法选择我院血液净化中心规律血液透析患者52例，按隧道式带涤纶套导管是否血栓栓塞分为2组，血栓栓塞组（A组）15例、无血栓栓塞组（B组）37例。回顾性分析2组血栓弹力图、凝血常规和血常规。结果①A组和B组间血红蛋白和凝血常规各指标差异无统计学意义，血红蛋白水平分别为（89．10±21．30）g／L、（92．30±24．60）g／L（P=0．380〉0．05），国际标准化比值分别为（1．06±0．07）、（1．05±0．09）（P=0．220〉0．05），活化部分凝血时间分别为（37．33±7．21）、（37．42±4．40）（P=0．740〉O．05），凝血酶原时间分别为（13．49±0．71）、（13．90±0．91）（P=0．770〉0．05），凝血酶时间分别为（16．30±1．40）、（15．60±1．80）（P=0．09〉0．05）；②A组血小板计数为（191．60±45．19）×10^9／L，较B组的（172．70±37．42）×10^9／L显著升高，差异有统计学意义（P=0．04〈0．05）；③血栓弹力图中，与B组比较，A组患者凝固角、最大振幅值、凝血指数值增大，差异有统计学意义（P〈0．05），凝血反应时间、血凝块形成时间缩短，差异均有统计学意义（P〈0．05），明显提示A组存在高凝状态。结论血栓弹力图较之常规凝血指标能及早判断血液透析患者的高凝状态，对血液透析隧道式带涤纶套导管血栓形成倾向监测有很大的帮助。

Objective To discuss the thromboelastograph for the detection of blockage in silicone dual-lumen catheters with a Dacron cuff in maintenance hemodialysis patients. Methods A total of 52 maintenance hemodialysis patients in our blood purification center were enrolled in this study, and divided into the presence of silicone dual-lumen catheters with a Dacron cuff embolism group （group A, n = 15） and the absence of silicone duallumen catheters with a Dacron cuff embolism group （group B, n = 37）. Thromboelastograph, conventional coagulation examinations and blood routine tests were performed retrospectively. Results There were no differences in hemoglobin and conventional coagulation parameters between the two groups（P〉0. 05）. There were also no statistically significant differences between two groups in international normalized ratio [（1.06 ± 0. 07） vs. （1.05 ± 0. 09）], activated partial thromboplastin time [（37. 33 ±7. 21） vs. （37. 42 ± 4. 40） s], prothrombin time[ （13.49 ± 0. 71） vs. （13.90 ± 0. 91） s], and thrombin time[（16. 30 ±1.40） vs. （15. 60 ±1.80） s]. The number of platelets was markedly increased in group A as compared with that in group B [（191.60 ± 45.19）×10^9/L vs. （172. 70 ± 37. 42）×10^9/L, p = 0. 04〈0. 05-]. As compared with group B, the thromboelastograph parameters including α-Angle, maximum amplitude and coagulation indexes were significantly increased （P〈0. 05） and the levels of coagulation reaction time and clots forming time significantly decreased （P〈0. 05, or P〈0. 01）, suggesting the presence of hypercoagulation status in group A. Conclusions Thromboelastograph disclosed the hypercoagulation status earlier than other conventional coagulation examinations in maintenance hemodialysis patients. Throm- boelastograph is helpful for the prediction of thrombosis formation predisposition in silicone dual-lumen catheters with a Dacron cuff in maintenance hemodialysis patients.