基于血栓弹力图指导的抗凝管理在静脉-动脉体外膜肺氧合中的可行性研究

Feasibility of thromboelastography based anticoagulant management in veno-arterial extracorporeal membrane oxygenation

目的探究基于血栓弹力图(thromboelastography,TEG)的抗凝管理在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)中的安全性和有效性。方法纳入2015年9月至2022年4月在徐州市中心医院因暴发性心肌炎需行ECMO治疗的患者54例,采用随机数字表法将患者分为两组:活化部分凝血活酶时间(activated partial thromboplastin time,APTT)组(26例)和TEG组(28例),分别以TEG或APTT指导患者的抗凝管理。收集并记录两组患者一般资料、相关合并症、住院病死率、死亡相关并发症、出血相关事件及血栓形成相关事件的发生率,同时记录血液、凝血相关指标及输血量等。结果两组患者一般资料、相关合并症、住院病死率及死亡相关并发症比较,差异无统计学意义(P>0.05)。两组患者出血相关事件和血栓形成相关事件发生率比较,差异无统计学意义(P>0.05)。TEG组肝素用量、APTT比率、R时间低于APTT组(P<0.05);TEG组红细胞和血小板输注量少于APTT组(P<0.05)。结论在静脉-动脉ECMO(veno-arterial-ECMO,VA-ECMO)期间,使用TEG进行抗凝管理相较于APTT是安全可行的,并不增加相关恶性并发症的发生率,且TEG组有较低的出血和血栓形成风险的发生,并有潜力减少ECMO治疗期间相关血液制品的用量。

Objective To explore the safety and effectiveness of thromboelastography(TEG)based anticoagulant management in extracorporeal membrane oxygenation(ECMO).Methods A total of 54 patients who underwent ECMO treatment in Xuzhou Central Hospital due to explosive myocarditis from September 2015 to April 2022 were included.According to the random number table method,they were divided into two groups:an activated partial thromboplastin time(APTT)group(n=26)and a TEG group(n=28).Their anticoagulation management was guided by TEG or APTT.The general information,related complications,in-hospital mortality,death related complications,and the incidence of bleeding and thrombosis events were recorded.Their blood,coagulation related indicators and blood transfusion volume were recorded.Results There was no statistical difference between the two groups in general information,related complications,in-hospital mortality and death related complications(P>0.05).There was no statistical difference in the incidence of bleeding related events and thrombosis related events between the two groups(P>0.05).The TEG group showed decreases in heparin dosage,APTT ratio and R time,compared with the APTT group(P<0.05).The transfusion volume of erythrocytes and platelet in the TEG group was less than that in the APTT group(P<0.05).Conclusions During veno-arterial ECMO(VA-ECMO),it seems feasible to use TEG for anticoagulant management,compared with APTT,without increases the incidence of related malignant complications.The TEG group presents a low risk of bleeding and thrombosis and shows potential to reduce the amount of blood products during ECMO treatment.