血栓弹力图在肝病中的应用进展

Advances in the application of thromboelastography in patients with liver disease

肝病患者的凝血障碍被认为是脆弱的"再平衡"状态, 临床常用的常规凝血试验不能反映凝血过程的全貌, 因此应用受限。近年来, 血栓弹力图作为一种快速、实时评估全血凝血状态的检测手段发展迅速, 在肝病患者的诊疗中有着独特优势。该文综述了血栓弹力图在输血指导中的应用, 以及其与肝病严重程度、出血、血栓形成、病死率和常规凝血试验的关系。血栓弹力图虽然存在一定的不足, 但能更好地反映肝病患者真实的凝血状态, 有助于减少血液制品的使用。虽然儿科相关资料稀少, 但血栓弹力图单独或与常规凝血试验联合使用都具有广阔的前景。

Coagulopathy in patients with liver disease is considered to be a fragile"rebalancing"state.Conventional coagulation test commonly used in clinic can not reflect the whole process of coagulation,so its application is limited.In recent years,thromboelastography has developed rapidly as a rapid and real-time detection method to evaluate the coagulation status of whole blood,and has unique advantages in the application of liver disease.The article reviews the application in transfusion guidance of thromboelastography and its association with severity of liver disease,bleeding,thrombosis,mortality and conventional coagulation testing.Although thromboelastography has some shortcomings,it can better reflect the real coagulation state of patients with liver disease and help reduce the use of blood products.Pediatric data are scarce,but the use of thromboelastography alone or in combination with conventional coagulation test will have broad prospects.