肝移植术后血栓弹力图与凝血试验相关因素分析

The correlation analysis of thromboelastography and coagulation function test of patients after liver transplantation

目的探讨肝移植术后患者血栓弹力图(TEG)与凝血试验各指标的相关性,评价2种方法在肝移植围术期的应用价值,为临床监测肝移植术后患者凝血功能变化提供一定的指导。方法回顾性分析2016年5月至2018年5月南京中医药大学附属八一医院择期或急诊行肝移植术47例患者的临床资料,所有患者于手术结束后转入ICU并在30min内完成血液标本采集,在2h内完成TEG、常规凝血试验和血小板(PLT)计数检测。分析患者TEG检测中反应时间(R值)、血块形成速率参数(K值)、最大切角(α角)、最大振幅(MA值)与凝血试验中凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)及PLT之间的相关关系。结果①R值与APTT显著相关(P=0.010);K值与APTT、PLT显著相关(P=0.020,0.012);α角与APTT、PLT、MA值显著相关(P=0.002,0.004,0.014);R值、MA值、K值、α角任意两者之间相关(P<0.05);②R值与APTT呈线性相关(P=0.001);MA与FIB、PLT呈线性相关(P=0.006,0.013);MA与K、α角呈线性相关(P=0.008,0.000)。结论肝移植术后患者的TEG指标与常规凝血试验检测指标存在明显相关,两者在肝移植患者术后凝血功能监测中都具有重要作用。

Objective To evaluate the clinical values of thromboelastography and coagulation function tests applied in the perioperative period of liver transplantation by investigating the correlation of parameters of the above methods and further provide some guidelines for monitoring the changes of coagulation function of patients after receiving liver transplantation.Methods We retrieved the datum of the patients who underwent emergency or selective liver transplantation in our hospital.All patients were transferred to ICU after surgery.Blood sample were collected within 30 minutes and TEG tests were conducted,routine coagulation test and platelet count(PLT)in 2 hours.We analyzed the correlation between the parameters of TEG and routine coagulation test and platelet count.Results ①According to the results of correlation analysis,R value was significantly correlated with APTT(P=0.010).K value was significantly correlated with APTT and PLT(P=0.020,0.012).Angle was significantly correlated with APTT,MA and PLT(P= 0.002,0.004,0.014).Each of them was correlated in R value, MA,K value and Angle (P<0.05).② R value and APTT showed a linear relation(P=0.001).MA and FIB,PLT showed a linear relation respectively(P=0.006,0.013).MA and K value,Angle showed a linear relation respectively (P=0.008, 0.000).Conclusion There is a significant correlation between TEG and coagulation test after liver transplantation.Both of them play an important role in monitoring patients' coagulation function during perioperative period.