血栓弹力图指导腹部术后出血可能的输血治疗

Thromboelastography may guide postoperative transfusion therapy after abdominal surgery

目的探讨血栓弹力图(TEG)在腹部外科术后成分输血、预测术后出血风险以及判断预后中的价值。方法选取南京大学医学院附属金陵医院普通外科2015年9月至2016年5月行腹部大手术后怀疑有出血可能的患者83例,随机分为TEG组(共39例)和对照组(共44例)。检测TEG和常规凝血,TEG组根据TEG检测结果输血,对照组根据常规凝血检测采取经验性输血。统计分析成分输血量、并发症、术后活动性出血、治愈率、ICU入住时间、总住院时间等。结果 TEG检测阳性率显著高于常规凝血功能检查阳性率(56.62%vs 25.30%,P<0.01)。TEG组血浆、血小板和冷沉淀的输入量显著减少(P均<0.01),MA与输血量有显著负相关(r=-0.57,P<0.01),MA值越低,输血量越多。根据TEG进行输血治疗能够有效减少并发症的发生(23.1%vs 45.5%,P=0.03);入住ICU时间(d)明显减少(3.3±1.3 vs 5.9±2.0,P<0.01),总住院时间(d)差异无统计学意义(13.4±4.0 vs 14.8±4.3,P=0.119)。结论根据TEG可个体化指导术后输血治疗,减少输血量以及判断活动性出血,提高腹部术后预后。

Objective To investigate the value of thromboelastography （TEG） in guiding postoperative component blood transfusion, and predicting the risk of postoperative bleeding and prognosis after abdominal surgery. Methods Eighty-three patients suspected bleeding after abdominal surgery from our hospital during September 2015 and May 2016 were enrolled, and randomly divided into TEG group （n = 39 ） and control group （n = 44）. All of patients were detected TEG and routine coagulation parameters, and the blood trans- fusion in TEG group was based on the TEG results, and that in control group based on the routine coagulation parameters. Meanwhile, the data such as the volume of component blood transfusion, complication, cure rate, stay time of intensive care unit（ICU） , length of stay and postoperative active bleeding were collected and analyzed. Results The positive rate of TEG was significant higher than that of routine coagulation parameters（56.62% vs 25.30% , P 〈 0.01 ）. The volume of plasma, platelet or cryoprecipitate transfusion in TEG group decreased significantly（P 〈 0.01 ）. The maximal amplitude （MA） value in TEG was negatively related to the volume of transfusion（ r = -0.57, P 〈 0.01 ）. The postoperative transfusion therapy based on the results of TEG could effectively reduce the oc- currence of complications （23.1% vs 45.5 % , P = 0.03 ）. Moreover, the stay time of ICU in TEG group was significantly shorter than that in control group [ （3.26 ± 1.29） d vs （5.89 ± 1.96） d, P 〈 0. 01 ], although there was no significant difference in length of stay [ （13.34 ± 3.96） d vs（ 14.78 ± 4.32） d, P = 0. 119] between the two groups. Conclusion The postoperative transfusion therapy based on TEG may reduce the volume of blood transfusion, assess active bleeding and improve prognosis after abdominal surgery.