血栓弹力图评估宫颈癌患者围手术期凝血状态的临床研究

Clinical study of thrombelastogram to evaluate perioperative coagulation status in patients with cervical cancer

目的:探讨血栓弹力图(Thrombelastogram,TEG)评估宫颈癌患者围术期凝血状态的应用价值。方法:选择2019年1月—2020年12月我院接受手术治疗子宫疾病患者70例,分为宫颈癌组(40例)与子宫良性疾病组(30例)。观察术前血栓弹力图检测的R、K、MA、Angel、CI参数,比较宫颈癌组和子宫良性疾病组TEG。结果:与子宫良性疾病组相比,宫颈癌组TEG的K值和R值均缩小(P<0.01),MA、Angel、CI值均增大(P<0.01),凝血功能FIB、DD升高(P<0.01);子宫良性疾病组术后均未出现下肢静脉血栓,宫颈癌组术后有6例出现下肢静脉血栓,宫颈癌组血栓阳性病例与阴性病例TEG各指标的差异有统计学意义(P<0.05)。结论:宫颈癌患者围手术期血液易处于高凝状态,与常规凝血功能相比,TEG能更全面准确地评估宫颈癌患者围手术期凝血状态。宫颈癌患者术前血液高凝状态是术后发生静脉血栓的高危因素,应根据患者病情及实验室检查指标在术后个体化制定预防血栓形成的方案,降低血栓栓塞的发生率。

Objective:To study the value of Thromboelastogram(TEG)in evaluating the perioperative coagulation state of patients with cervical cancer.Methods:A total of 70 cases with uterine disease from January 2019 to December 2020 were selected in Ganzhou Cancer Hospital.They were divided into cervical cancer(n=40)and a benign uterine disease(n=30).The values of R,K,MA,Angel,and CI of thrombelastogram between the two groups were collected and compared.Results:Compared with the benign group,R and K values of TEG were shorter(P<0.01),MA,Angel and CI values were wider(P<0.01),and the coagulation FIB,DD were higher(P<0.01)in cervical cancer group.No cases of venous thrombosis had occurred in the benign uterine disease group,6 cases in the cervical cancer group developed a lower limb venous thrombosis after surgery.There were significant differences(P<0.05)between positive versus negative groups with lower limb venous thrombosis.Conclusion:Perioperative blood in patients with cervical cancer is prone to a high coagulation state,and TEG can evaluate it more comprehensively and accurately then conventional coagulation function.Preoperative blood hypercoagulation status is a high risk factor for postoperative venous thromboembolism in cervical cancer patients.Therefore,to reduce the incidence of thromboembolism,an individualized thrombosis prevention plan according to the patient's condition and laboratory examination indicators should be formulated after surgery.