血栓弹力图检测在指导心脏术后患儿成分输血中的应用价值

Application value of thromboelastography in guiding component blood transfusion in children after heart surgery

目的探讨血栓弹力图(TEG)检测在指导心脏术后患儿成分输血中的应用价值。方法选择心脏术后患儿103例,均在输血前检测TEG,根据R值、K值及MA值分别将患儿分为R值正常组(R≤10 min)85例及R值延长组(R>10 min)18例;K值正常组(K≤3 min)47例及K值延长组(K>3 min)56例;MA值正常组(MA≥50 mm)42例及MA值降低组(MA<50 mm)61例,记录其术后血浆和PLT的输注情况,比较组间术后输血情况以及输血前后相应的参数值。结果 R值延长组、K值延长组术后输注血浆者比例及血浆输注量分别高于R值正常组、K值正常组(P<0.05);R值延长组、K值延长组输注血浆后相应参数较前缩短,而R值正常组、K值正常组输注血浆前后相应参数无明显变化(P>0.05)。MA值降低组术后输注PLT者比例及PLT输注量均高于或多于MA值正常组(P<0.05),但两组术后输注血浆者比例及血浆输注量比较差异均无统计学意义(P>0.05);MA减低组输注PLT后MA值较前升高(P<0.05),而MA正常组输注PLT前后MA值无明显变化(P>0.05)。结论 TEG的R值、K值和MA值对心脏术后患儿成分输血具有指导意义。

Objective To explore the application value of thromboelastography（TEG） in guiding the component blood transfusion in children after heart surgery. Methods A total of 103 children who had received heart surgery underwent TEG before blood transfusion. The children were divided into normal R group（ R ≤ 10 minutes, n = 85 ） and prolonged IR group（ R 〉 10 minutes, n = 18 ） ;normal K group （ K ≤ 3 minutes, n = 47 ） and prolonged K group （ K 〉 3 minutes, n = 56 ） ; normal MA group （ MA ≥ 50 mm, n = 42 ） and decreased MA group（ MA 〈 50 mm, n = 61 ） according to the R value, K value and MA value respectively. The postoperative transfusion of PLT and plasma was recorded. The condition of transfusion and the corresponding parameters before and after transfusion were compared between groups. Results The proportion of eases with plasma transfusion and the plasma transfusion volume in the prolonged R group and prolonged K group were higher/more than those in the normal R group and normal K group respectively （ P 〈 0.05 ） ; the corresponding parameters of the prolonged R group and the prolonged K group decreased after plasma transfusion （P 〈 O. 05 ） , but no significant changes were observed in the corresponding parameters of normal R group or normal K group before or after plasma transfusion （ P 〉 0.05 ）. The proportion of cases with PLT transfusion and the PLT transfusion volume in the decreased MA group were higher/more than those in the normal MA group （ P 〈 0.05 ）, but there was no significant difference in the proportion of cases with plasma transfusion or the plasma transfusion volume between the two groups after operation（ P 〉 0.05 ）. The MA value of the decreased MA group increased after PLT transfusion（ P 〈 0.05 ） , but no significant change was observed in the MA value of the normal MA group after PLT transfusion （ P 〉 0.05 ）. Conclusion The R, K and MA values of TEG contribute to guiding the component blood transfusion in children after heart surgery.