血栓弹力图与常规凝血指标对腰椎术后下肢深静脉血栓形成的预测价值

Predictive Value of Thromboelastogram and Conventional Coagulation Indexes for Deep Vein Thrombosis of Lower Limbs After Lumbar Spine Surgery

目的探讨血栓弹力图(TEG)与常规凝血指标在腰椎手术围术期预测下肢深静脉血栓(DVT)形成的临床诊疗价值。方法回顾性分析2015年9月至2019年9月在郑州大学第二附属医院行腰椎手术的患者105例。其中术中未用氨甲环酸(TXA)止血,术后用低分子肝素钙(LMWHC)抗凝者35例,作为A组;术中应用TXA止血,术后用LMWHC抗凝者35例,作为B组;术中应用TXA止血,术后用利伐沙班抗凝者35例,作为C组。收集各组围手术期TEG与凝血功能相关数据,进行相关性与一致性分析。抗凝终点时行下肢静脉超声,根据DVT的发生情况,分为DVT组和非DVT组,应用受试者工作特征(ROC)曲线分析TEG与传统凝血指标预测DVT的临床价值。结果3组的TEG与传统凝血指标在各时间点变化均有统计学意义(均P<0.05)。A、B组间仅凝血时间(reaction time,R)差异有统计学意义(P<0.05),B、C组除国际标准化比值(INR)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)外,其余指标组间差异均有统计学意义(均P<0.05)。3组凝固时间(clotting time,K)与PT具有较好的相关性及一致性;A、C组R与APTT相关性与一致性较好;A组最大振幅(MA)与纤维蛋白原(Fib)、B组K与APTT、C组R与PT等相关性及一致性均有统计学意义(均P<0.05)。DVT组R、K、凝集块形成速率(α角)、MA、综合凝血指数(CI)、INR及PT等指标均高于非DVT组,差异均有统计学意义(均P<0.05),ROC曲线显示α角、MA及CI预测DVT发生的价值较高。结论TEG对腰椎术后凝血状态变化情况的检测具有更高的准确度及敏感度,TEG可有效预测DVT的发生,指导抗凝治疗,值得临床应用。

Objective The state of hypercoagulable blood after lumbar spine surgery has an important impact on the formation of deep vein thrombosis(DVT)in the lower extremities.This article discusses the clinical diagnosis and treatment value of thrombelastography(TEG)and conventional coagulation indexes in the perioperative period of lumbar spine surgery to predict deep vein thrombosis of the lower extremities.Methods A retrospective analysis of 105 patients who underwent lumbar spine surgery in the Second Affiliated Hospital of Zhengzhou University from September 2015 to September 2019 was performed.Tranexamic acid(TXA)was not used to stop bleeding during the operation and 35 cases were treated with low molecular weight heparin calium(LMWHC)for anticoagulation after the operation(group A).TXA was used to stop bleeding during the operation.After LMWHC anticoagulation,35 cases were treated as group B.TXA was used to stop bleeding during the operation,and 35 cases were treated with rivaroxaban after operation,as group C.Data related to TEG and coagulation function during perioperative period of each group were collected,and the correlation and consistency analyzed.Under the anticoagulation endpoint,the lower extremity vein ultrasound was performed.According to the occurrence of DVT,the patients were divided into DVT group and non-DVT group.Receiver operating characteristic(ROC)curve was used to analyze the clinical value of TEG and traditional coagulation indexes to predict DVT.Results The TEG and traditional coagulation indexes of the 3 groups changed statistically at each time point(P<0.05).There was significant differece in the coagulation time(reaction time,R)between groups A and B(P<0.05).There were no signficant differences in the international normalized ratio(INR),prothrombin time(PT),or activated partial thromboplastin time(APTT)between groups A and B(P>0.05),but significant differences were found in the other indicators between the groups(P<0.05).In the three groups,clotting time(K)and PT had strong correlation and consistency.In groups A and C,R and APTT had good correlation and consistency.In group A,maximum amplitude(MA)and fibrin in group A,K and APTT in group B,and R and PT in group C had statistically significant correlation and consistency(P<0.05).The R,K,clot formation rate(αangle),MA,coagulation index(CI),INR and PT in the DVT group were significantly higher than those in the non-DVT group(all P<0.05).ROC curve showedα,MA and CI indicators had higher value in predicting the occurrence of DVT.Conclusion TEG has higher accuracy and sensitivity in detecting changes in coagulation status after lumbar spine surgery.TEG can effectively predict the incidence of DVT,guide anticoagulation therapy,and is worthy of clinical application.