血栓弹力图指导临床输血在恶性肿瘤术后凝血异常患者中的应用

Application of thromboelastography in guiding clinical blood transfusion in patients with coagulation abnormalities after operation of malignant tumors

目的:分析血栓弹力图(thromboelastography,TEG)指导临床输血在恶性肿瘤术后凝血异常患者中的应用效果。方法:按随机数表法,将60例恶性肿瘤术后凝血异常患者分为观察组和对照组,每组各30例。对照组进行常规检测输血,观察组进行TEG检测输血。比较两组患者输血前后的凝血指标[凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)及纤维蛋白原(fibrinogen,FIB)]及治疗期间输注血液数量[浓缩红细胞(concentrated red bloodcells,CRC)、新鲜冰冻血浆(fresh frozen plasma,FFT)、冷沉淀凝血因子(cryopreserved plasma,CRYO)及血小板(platelet count,PC)],比较观察组患者输血前后的凝血反应时间(R)、凝血形成时间(K)、血块形成速率(Angle°)、血凝块最大强度(MA)、总体凝血指数(CI)。结果:输血后,观察组患者的PT、APTT及TT低于对照组,FIB高于对照组,CRC、FFP输血量少于对照组,差异具有统计学意义(P<0.05);观察组患者的CRYO、PC输血量与对照组相比,差异无统计学意义(P>0.05)。观察组的血块形成速度小于对照组(P<0.05),血块形成温度和最大血块强度大于对照组(P<0.05)。结论:TEG指导恶性肿瘤术后凝血异常患者的临床输血,能够有效改善凝血异常情况,有针对性地增加患者血凝质量。

Objective:To analyze the effect of thromboelastography (TEG) on clinical transfusion in patients with coagulation abnormalities after malignant tumor surgery.Methods:60 patients with postoperative coagulation abnormalities of malignant tumors were selected as the study subjects.The patients were divided into observation group and control group according to the random number table method,30 cases in each group.The control group was routinely tested for blood transfusion,and the observation group was subjected to TEG to detect blood transfusion.Coagulation parameters before and after transfusion were compared between the two groups [prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),and fibrinogen (FIB)].The amount of blood transfused during the treatment period was compared between the two groups [concentrated red blood cells (CRC),fresh frozen plasma (FFT),cryopreserved plasma (CRYO),and platelet count (PC)].The coagulation reaction time (R),coagulation formation time (K),clot formation rate (Angle°),maximum clot strength (MA) and overall coagulation index (CI) of the patients in the observation group before and after transfusion were compared.Results:After blood transfusion,PT,APTT and TT in the observation group were lower than those in the control group,FIB was higher than that in the control group,CRC and FFP transfusion volume was lower than that in the control group,with statistical significance ( P <0.05).CRYO and PC transfusion volume in the observation group was not significantly different from that in the control group ( P >0.05).The rate of blood clot formation in the observation group was lower than that in the control group ( P <0.05),the temperature of blood clot formation and the maximum intensity of blood clot were higher than those in the control group ( P <0.05).Conclusion:TEG guides the clinical transfusion of patients with abnormal coagulation after operation of malignant tumors,which can effectively improve the abnormal coagulation and improve the quality of blood coagulation.