基于血栓弹力图监测对氨甲环酸治疗急性消化道出血患者临床疗效分析

Clinical Efficacy of Tranexamic Acid in the Treatment of Acute Gastrointestinal Bleeding by Thromboelastography

目的探讨血栓弹力图(TEG)对氨甲环酸(TXA)治疗急性消化道出血(GIB)患者的监测价值,采用TEG评价TXA的临床疗效。方法选取2019年10月至2020年12月因急性GIB于四川大学华西医院急诊科诊疗的74例患者为研究对象,按照随机数字表法分为试验组和对照组,每组37例。对照组给予注射用艾司奥美拉唑钠和注射用生长抑素治疗,试验组在对照组治疗基础上联合TXA氯化钠注射液静脉滴注治疗。治疗前后对两组进行TEG和血常规检测,收集并计算患者的住院时间、介入手术率、输血率及输血量、不良反应发生率、并发症发生率及出院28 d病死率。结果试验组治疗前后凝血反应时间(R)差异有统计学意义(P<0.05);血凝块形成时间(K)、血凝块形成最大切角(α)、TEG描记图最大振幅(MA)、血块溶解百分比预测值(EPL)和MA达到30 min血块溶解百分比(LY30值)差异均无统计学意义(P>0.05);对照组治疗前后R、K、α、MA、EPL和LY30值差异均无统计学意义(P>0.05)。两组TEG参数、血常规参数、住院时间、介入手术率、输血率及输血量、不良反应发生率、并发症发生率及出院28 d病死率比较,差异均无统计学意义(P>0.05)。结论急性GIB患者凝血功能活跃,而纤溶功能不亢进;抗纤溶剂TXA对急性GIB患者没有明显临床疗效。

Objective To evaluate the clinical efficacy of tranexamic acid(TXA)in the treatment of acute gastrointestinal bleeding(GIB)by thromboelastography(TEG)and the value of TEG.Methods A total of 74 patients with acute GIB treated in the emergency department of West China Hospital of Sichuan University from October 2019 to December 2020 were included.They were divided into experimental group(n=37)and control group(n=37)according to random number table method.The control group was treated with esomeprazole sodium for injection and somatostatin for injection,while the experimental group was treated with TXA sodium chloride injection intravenously for on the basis of the treatment of the control group.TEG and routine blood tests were performed before and after treatment.Length of hospital stay,rate of interventional surgery,rate and volume of blood transfusion,incidence of adverse reactions,incidence of complications and case fatality rate within 28 d after discharge were recorded and analyzed.Results In the experimental group,there was significant difference in R value(clotting reaction time)before and after treatment(P<0.05),but there was no significant difference in K(clot formation time),α(maximum incisal angle of clot formation),MA(maximum amplitude of TEG mapping),EPL(predicted percentage of clot dissolution)and LY30(percentage of clot lysis when MA reaches 30 minutes)(P>0.05).There was no significant difference in R,K,α,MA,EPL and LY30 before and after treatment in the control group.There was no significant difference between the two groups in TEG parameters,blood routine parameters,length of hospital stay,rate of interventional surgery,rate and volume of blood transfusion,incidence of adverse reactions,incidence of complications and case fatality rate within 28 d after discharge(P>0.05).Conclusion Patients with acute GIB have active coagulation function but inactive fibrinolysis function.Antifibrotic solvent TXA has no obvious effect in the treatment of acute GIB.