血栓弹力图指导的输血应用于体外循环心脏手术围手术期的效果

Perioperative effect of blood transfusion guided by thromboelastography in cardiac surgery with cardiopulmonary bypass

目的探讨血栓弹力图指导的输血应用于体外循环心脏手术围手术期的效果。方法本研究为随机对照试验。将中国人民解放军陆军第七十三集团军医院2020年6月至2022年6月期间收治的84例体外循环心脏手术患者按照随机数字表法分为观察组和对照组,对照组42例中男24例,女18例,年龄19~71(51.78±7.56)岁,根据常规凝血实验进行输血指导;观察组42例中男25例,女17例,年龄19~71(53.12±7.29)岁,根据血栓弹力图进行输血指导。观察两组输血情况、输血效果以及临床结局。统计学方法采用独立样本t检验、χ^(2)检验、Fisher确切概率法。结果观察组自体血液、红细胞输入量分别为(734.62±61.78)ml、(549.16±87.47)ml,对照组分别为(748.25±67.96)ml、(559.94±92.35)ml,差异均无统计学意义(均P>0.05)。观察组新鲜冷冻血浆、血小板输入量为(321.39±65.53)ml、(523.27±152.45)ml,对照组分别为(375.44±71.83)ml、(655.29±187.63)ml,差异均有统计学意义(均P<0.05)。观察组手术完成、转出重症监护室(ICU)时的血红蛋白水平均高于对照组[(105.77±10.34)g/L比(91.23±9.75)g/L、(118.35±10.57)g/L比(105.59±9.23)g/L],输血后1 h、24 h的血小板计数增高指数(CCI)均高于对照组[(15.24±4.48)比(12.62±3.47)、(13.87±2.19)比(10.58±2.54)],输血有效率高于对照组[83.33%(33/42)比61.90%(24/42)],差异均有统计学意义(均P<0.05);观察组气管插管时间[(19.27±5.56)h比(21.75±5.21)h]、ICU入住时间[(21.17±4.64)h比(23.83±5.13)h]、住院时间[(16.52±4.57)d比(19.21±5.17)d]均短于对照组,差异均有统计学意义(均P<0.05),观察组术后24 h内再次手术率、病死率与对照组比较差异均无统计学意义(均P>0.05)。结论血栓弹力图指导的输血应用于体外循环心脏手术围手术期有助于减少输血量,增强输血效果,缩短患者气管插管时间、ICU入住时间及住院时间,改善预后。

Objective To investigate the perioperative effect of blood transfusion guided by thromboelastography in cardiac surgery with cardiopulmonary bypass.Methods It was a randomized controlled trial.A total of 84 patients undergoing cardiac surgery with cardiopulmonary bypass admitted in The 73rd Group Military Hospital of the Chinese People's Liberation Army Ground Force from June 2020 to June 2022 were divided into an observation group and a control group according to the random number table method.In the control group,there were 24 males and 18 females,aged 19-71(51.78±7.56)years.In the observation group,there were 25 males and 17 females,aged 19-71(53.12±7.29)years.The control group received blood transfusion guidance according to the routine coagulation test,and the observation group received blood transfusion guidance according to the thromboelastography.The blood transfusion situation,blood transfusion effects,and clinical outcomes of the two groups were observed.Independent sample t test,χ^(2) test,and Fisher exact probability method were used for statistical analysis.Results The amounts of autologous blood and erythrocyte input were(734.62±61.78)ml and(549.16±87.47)ml in the observation group,and(748.25±67.96)ml and(559.94±92.35)ml in the control group,without statistically significant differences between the two groups(both P>0.05).The amounts of fresh frozen plasma and platelet input were(321.39±65.53)ml and(523.27±152.45)ml in the observation group,and(375.44±71.83)ml and(655.29±187.63)ml in the control group,respectively,with statistically significant differences between the two groups(both P<0.05).The level of hemoglobin in the observation group was higher than that in the control group at the time of operation completion and transfer out of intensive care unit(ICU)[(105.77±10.34)g/L vs.(91.23±9.75)g/L,(118.35±10.57)g/L vs.(105.59±9.23)g/L],the platelet elevation index(CCI)was higher than that in the control group 1 h and 24 h after transfusion[(15.24±4.48)vs.(12.62±3.47),(13.87±2.19)vs.(10.58±2.54)],and the effective rate of blood transfusion was higher than that in the control group[83.33%(33/42)vs.61.90%(24/42)],with statistically significant differences between the two groups(all P<0.05).The time of tracheal intubation[(19.27±5.56)h vs.(21.75±5.21)h],the length of ICU stay[(21.17±4.64)h vs.(23.83±5.13)h],and the length of hospital stay[(16.52±4.57)d vs.(19.21±5.17)d]in the observation group were all shorter than those in the control group,with statistically significant differences(all P<0.05).There were no statistically significant differences in the rate of re-operation within 24 h after operation and mortality rate between the observation group and the control group(both P>0.05).Conclusion The application of blood transfusion guided by thromboelastography in the perioperative period of cardiac surgery with cardiopulmonary bypass is helpful to reduce the amount of blood transfusion,enhance the effect of blood transfusion,shorten the time of tracheal intubation,length of ICU stay,and length of hospital stay,and improve the prognosis.