TEG对指导外科手术时输血治疗的应用评价

TEG transfusion treatment at the time of surgery to guide the application of evaluation

目的探讨血栓弹力图(TEG)在外科手术时最佳输血策略的指导意义。方法回顾性分析2016年6月至2017年10月该院收治入院的89例行外科手术,且术前预估出血量在1 000mL以上患者病例资料,其中38例未行TEG指导常规输血,纳入对照组;51例在TEG相关指标指导下完成输血,纳入观察组。比较两组患者输血前、输血后即刻及输血后24h凝血指标监测结果及输注各类血液制品用量,分析观察组输血前后TEG相关指标变化情况。结果两组患者术前、术后即刻及术后24h血红蛋白、红细胞压积、血小板计数比较差异均无统计学意义(P>0.05);两组术前凝血酶原时间及活化部分凝血酶原时间差异均无统计学意义(P>0.05);术后即刻及术后24h观察组明显低于对照组优,差异有统计学意义(P<0.05)。观察组治疗过程中输注浓缩红细胞、血小板、新鲜冰冻血浆及纤维蛋白用量均显著低于对照组,组间差异有统计学意义(P<0.05)。TEG指导后观察组患者输血后反应时间(R)、凝血酶原时间(K)及综合情况(Cl)明显降低,组间差异有统计学意义(P<0.05);纤维蛋白凝块形成及加固速率(Angle)、最大振幅(MA)明显升高,组间差异有统计学意义(P均<0.01)。观察组手术时间较对照组短,术中出血量明显低于对照组,组间差异有统计学意义(P<0.05);术后24h引流量比较,观察组明显少于对照组,组间差异有统计学意义(P<0.05),且观察组未见二次手术病例,组间差异有统计学意义(P<0.05)。结论 TEG指导外科手术最佳输血策略,不仅可及时纠正凝血功能异常,提高血液有效成分输注率,同时还能有效节约资源。

Objective To investigate the guidance significance of thrombelastogram（TEG）for the best blood transfusion strategy in surgical treatment.Methods A retrospective analysis was performed on 89 cases of patients with surgery and preoperative estimated bleeding volume over 1 000 mL from June 2016 to October2017 in our hospital,38 cases of no TEG guiding regular blood transfusion were set in the control group;51 cases of blood transfusion under TEG indexes guidance were set the observation group.Two groups were compared for blood coagulation index（hemoglobin,hematocrit,platelet count,prothrombin time and activated partial thromboplastin time）monitoring results and blood products infusion dosage before and after blood transfusion,and at 24 hafter blood transfusion,followed by analysis of TEG index changes before and after blood transfusion.Results The two groups′hemoglobin,hematocrit,platelet count before and after surgery,immediately at 24 hafter surgery showed no statistical difference（P〈0.05）;the two groups′preoperative prothrombin time and activated partial thromboplastin time held no distinct difference（P〈0.05）,the postoperative data and data at postoperative 24 hin observation group was apparently better than that of the control group,obvious differences was shown between groups（P〈0.05）.The observation group′s concentrated red blood cells,platelets,fresh frozen plasma and fibrin infusion dosage were obviously lower than those in the control group,and the difference between the groups was marked（P〈0.01）.After TEG guidance,the observation group′s R,K and Cl after transfusion decreased markedly,the difference between groups was evident（P〈0.01）,Angle and MA rose evidently,the difference was apparent（P〈0.01）.The operation time of the observation group was shorter than that of the control group,and the amount of bleeding during operation was apparently less than that of the control group,showing significant distance（P〈0.05）;Induced discharge at postoperative 24 hwas compared,data of observation group was smaller than that of the control group,there was significant difference between groups（P〈0.05）,and there was no second operation case in observation group,significant difference was shown between groups（P〈0.05）.Conclusion The best blood transfusion strategy in surgical treatment under the guidance of TEG can rectify abnormal coagulation function,promote blood active constituent infusion rate,as well as put saving in resource uses.