血栓弹力图预测急性脑梗死并发下肢深静脉血栓的应用进展

Progress in the application of thromboelastography in predicting acute cerebral infarction complicated with deep venous thrombosis in lower extremities

下肢深静脉血栓是急性脑梗死患者临床发生率较高的一类严重并发症,可引起肺动脉栓塞甚至死亡等严重后果,但目前临床上缺乏精准的预测指标,常在下肢深静脉血栓发生后再予以治疗,影响康复进程。血栓弹力图是近年来逐渐发展成熟的检测体内凝血状态的一种敏感的方法,能够动态的、全面反映血液凝固至纤维蛋白溶解的全过程,提供患者是否存在血液高凝状态的证据,为临床评估血栓形成风险、采取预防血栓形成方案等提供临床决策依据。血栓弹力图目前已广泛应用于监测凝血功能、指导抗凝方案和预测重型颅脑损伤、恶性肿瘤、外科手术后深静脉血栓形成风险等广泛领域。本文从血栓弹力图的基本概念、评估高凝状态价值、与传统预测下肢深静脉血栓指标对比的优劣势、不足之处以及研究展望等方面对血栓弹力图在预测急性脑梗死并发下肢深静脉血栓风险中的价值进行整理与总结。

Deep venous thrombosis in lower limb(LDVT)extremity is a common serious complication of acute cerebral infarction(ACI),which can cause serious consequences such as pulmonary embolism and even death.However,there is currently a lack of accurate predictive indicators in clinical practice,and treatment is often given after the occurrence of LDVT.Thromboelastogram(TEG)is a sensitive method that has gradually matured in recent years to detect the coagulation state in the body.It can dynamically and comprehensively reflect the process from blood coagulation to fibrinolysis,provide evidence of the existence of hypercoagulable state in patients,and help clinical decision-making.TEG has been widely used in monitoring coagulation function,guiding anticoagulation program and predicting the risk of LDVT after severe brain injury,malignant tumors and surgery.This article reviews the value of TEG in predicting the risk of ACI complicated with LDVT from the following aspects:the basic concept of TEG,the value of evaluating hemagglutination state,the advantages and disadvantages of TEG compared with the traditional indicators of predicting LDVT and the research prospects.