血栓弹力图预测肝移植术中大量输血及指导备血的研究

Study of thromboelastography in predicting massive blood transfusion and guiding blood preparation before liver transplantation

目的探讨血栓弹力图(thromboelastography,TEG)在肝移植术前预测大量输血(massive transfusion,MT)及指导术前备血方面的价值,以优化术中血液制品使用方案。方法选取2014—2019年首都医科大学附属北京佑安医院行肝移植手术的患者128例,根据术中输血量分为MT组(输血量>10个单位悬浮红细胞,56例)和非MT组(72例);收集术前凝血功能及TEG检测结果,采用ROC分析各指标对术中MT的预测价值;分析TEG指标与血制品用量的相关性并建立术前备血模型方程。结果在预测肝移植术中MT方面,TEG最大振幅(maxium amplitude,MA)具有最大的AUC0.817,MA<42.5 mm预测MT的敏感性为75.0%,特异性为83.3%。多项TEG指标与术中血制品输注有相关性,其中MA与术中红细胞、血小板、血浆3种血制品输注均有较强相关性(r=-0.486,P=0.000;r=-0.322,P=0.000;r=-0.499,P=0.000)。结论TEG多项指标与术中血制品输注有相关性,MA对于肝移植术中MT具有较好的预测价值,术前TEG检测将有助于更有效地指导肝移植术前备血。

Objective To investigate the value of thromboelastography(TEG)in predicting massive transfusion(MT) and guiding preoperative blood preparation before liver transplantation,and to optimize the use of blood products.Methods Retrospective analysis was performed on 128 patients who underwent liver transplantation in Beijing Youan Hospital,Capital Medical University from 2014 to 2019.The patients were divided into MT group(blood transfusion amount more than 10 units,56 patients)and non-MT group(72 patients).Preoperative coagulation tests and TEG results were collected.ROC curve analysis was used to assess the value of different index in predicting MT.The correlation between each index and the amount of blood products was analyzed and the preoperative blood preparation model equation was established.Results In predicting MT before liver transplantation,the maximum amplitude of TEG(MA)had the maximum AUC of 0.817,the sensitivity and specificity of MA<42.5 mm for predicting MT were 75.0%and 83.3%.Multiple index of TEG had correlation with intraoperative blood product transfusion,and MA was strongly correlated with red blood cells,platelets and plasma transfusion(r=-0.486,P=0.000;r=-0.322,P=0.000;r=-0.499,P=0.000).Conclusions There is a correlation between TEG and intraoperative blood transfusion.MA has a good predictive value for intraoperative MT in liver transplantation.Preoperative TEG detection will help to guide the blood consumption during liver transplantation more effectively.