血栓弹力图监测肝脏疾病患者凝血功能及其对临床输血的应用研究

Study on the thromboelastography in monitoring coagulation function of patients with liver diseases andits application in clinical blood transfusion

目的研究在肝病患者凝血功能监测中应用血栓弹力图(TEG)方法联合常规检测的结果,以指导设计相应合理的临床输血方案。方法选择肝病患者和同期健康人群各64例,观察组分4亚组,设对照组1组;采用TEG检测并比较组间相应参数的差异,同时观察组采用常规凝血功能检测方法检测,比较两种试验方法监测指标间的相关性。结果 TEG检测观察组与对照组比较,观察组肝功能不全组的R值较对照组明显降低(P<0.05);乙型肝炎组和肝硬化组的R和MA值均较对照组明显降低(P<0.05);肝衰竭组的MA值较对照组明显降低(P<0.05)。TEG与常规凝血功能检测方法比较,观察组的PT、APTT和TT明显延长(P<0.05);FIB和AT-Ⅲ明显减低(P<0.05),F-Ⅷ活性增强(P<0.05)。两种试验方法相关性分析显示,APTT与R值呈正相关性(r=0.269,P<0.05);PLT与K值呈负相关性(r=-0.376,P<0.05)、与α值呈正相关性(r=0.383,P<0.05)、与MA值呈正相关性(r=0.569,P<0.05);FIB与K值呈负相关性(r=-0.398,P<0.05)、与α值呈正相关性(r=0.426,P<0.05)。结论 TEG检测各指标结果与凝血的常规方法的试验结果之间存在一定相关性;TEG在指导肝病患者治疗以及成分输血中有重要的指导价值。

Objective To study the thromboelastography(TEG)combined with routine detection in monitoring coagulation function of patients with liver disease in order to design the appropriate clinical blood transfusion scheme.Methods 64 patients with liver disease and 64 healthy people were selected.The observation group was divided into 4 subgroups,and one control group was set up.TEG was detected and the differences of corresponding parameters between the two groups were compared. At the same time,the observation group was detected by routine coagulation function test,and the correlation between the two methods was compared. Results Compared with the control group,the R value of the observation group was significantly lower than that of the control group ( P <0.05). The R and MA values of the hepatitis B group and the liver cirrhosis group were significantly lower than those of the control group ( P < 0.05 ). The MA value of the liver failure group was significantly lower than that of the control group ( P <0.05). Compared with conventional coagulation function test,PT,APTT and TT in the observation group were prolonged( P <0.05),FIB and AT-Ⅲ were decreased( P <0.05),and the activity of F-Ⅷ was enhanced( P <0.05). APTT was positively correlated with R value ( r =0.269, P <0.05). PLT was negatively correlated with K value ( r =-0.376, P <0.05),was positively correlated with α value ( r =0.383, P < 0.05 ),and positively correlated with MA value ( r =0.569, P <0.05). FIB was negatively correlated with K value ( r =-0.398, P < 0.05 ),and positively correlated with α value ( r =0.426, P <0.05). Conclusion There is a certain correlation between the results of TEG and the results of conventional coagulation methods. Thromboelastography (TEG) has important value in guiding the treatment of liver disease patients and blood component transfusion.