血栓弹力图与FIB联合预测普外科患者围术期大量输血的效能评价

Efficacy of thromboelastography and fibrinogen in predicting perioperative massive blood transfusion in patients undergoing general surgery

目的探讨血栓弹力图(TEG)与纤维蛋白原(FIB)联合预测普外科患者围术期大量输血的效能,以期为临床尽早制定合理用血方案提供参考依据。方法回顾性选取2021年9月1日至2023年9月1日驻马店市中心医院收治的182例普外科患者,根据围术期是否大量输血分为大量输血组(输血量≥18 U)(n=45)与非大量输血组(输血量<18 U)(n=137)。比较两组患者的临床资料、TEG参数[凝血时间指数(R)、凝固时间(K)、凝血形成速率(α角)、血栓最大幅度(MA)]和FIB水平,采用Pearson相关系数模型分析TEG参数与FIB的相关性,采用受试者工作特征曲线(ROC)及曲线下面积(AUC)评价TEG参数、FIB对普外科患者围术期大量输血的预测效能。结果大量输血组患者的R、K[(8.57±2.31)min、(3.72±0.68)min]明显高于非大量输血组[(6.68±1.75)min、(3.15±0.50)min],α角、MA、FIB[(44.88±4.17)°、(43.85±5.58)mm、1.(21±0.30)g/L]明显低于非大量输血组[(48.96±5.02)°、(49.76±6.41)mm、1.68±0.52g/L)],差异均具有统计学意义(P<0.05);经Pearson相关性分析结果显示,R、K与FIB呈负相关(r=-0.603、-0.6015,P<0.01),α角、MA与FIB呈显著正相关(r=0.589、0.622,P<0.01);R、K、α角、MA、FIB预测普外科患者围术期大量输血的AUC分别为0.755(95%CI:0.686~0.816)、0.806(95%CI:0.741~0.861)、0.752(95%CI:0.683~0.813)、0.789(95%CI:0.723~0.846)、0.807(95%CI:0.742~0.861),约登指数分别为0.449、0.493、0.399、0.484、0.590,最佳截断值为7.45 min、3.41 min、47.62°、45.86 mm、1.46 g/L,敏感度分别为73.33%、77.78%、80.00%、66.67%、91.11%,特异度分别为71.53%、71.53%、59.85%、81.75%、67.88%,各指标联合预测普外科患者围术期大量输血的AUC为0.924(95%CI:0.875~0.958),优于各指标单独预测;R、K高值的普外科患者围术期大量输血风险是低值患者的4.201倍(95%CI:2.329~7.580)、5.108倍(95%CI:2.700~9.663);α角、MA、FIB低值的普外科患者围术期输血风险是高值患者的4.000倍(95%CI:2.047~7.818)、4.618倍(95%CI:2.710~7.869)、11.697倍(95%CI:4.370~31.307)。结论TEG与FIB联合应用可用于普外科患者围术期输血效能预测中,为临床术前预测大量输血提供参考依据,以尽早制定相应输血方案,改善预后。

Objective To explore the efficacy of thromboelastography(TEG)and fibrinogen(FIB)in predict-ing perioperative massive blood transfusion in patients undergoing general surgery,in order to provide a reference for the early development of rational blood use schemes in clinic.Methods One hundred and eighty-two patients undergoing general surgery admitted to Zhumadian Central Hospital from September 1,2021 to September 1,2023 were retrospec-tively selected and divided into the massive transfusion group(blood transfusion≥18 U,n=45)and the non-massive transfusion group(blood transfusion<18 U,n=137)according to whether they were heavily transfused in the periopera-tive period.The clinical data,TEG parameters[coagulation time index(R),coagulation time(K),rate of clot formation(αangle),maximum amplitude of thrombus(MA)],and FIB levels of patients in the two groups were compared.The corre-lation between TEG parameters and FIB was analyzed using the Pearson correlation coefficient model,and the receiver op-erating characteristic(ROC)curve and area under the curves(AUC)were used to evaluate the predictive efficacy of TEG parameters and FIB for perioperative massive blood transfusion in patients undergoing general surgery.Results R and K in the massive transfusion group were(8.57±2.31)min and(3.72±0.68)min,significantly higher than(6.68±1.75)min and(3.15±0.50)min in the non-massive transfusion group;αangle,MA,FIB were(44.88±4.17)°,(43.85±5.58)mm,(1.21±0.30)g/L,significantly lower than(48.96±5.02)°,(49.76±6.41)mm,(1.68±0.52)g/L in non-massive transfusion group;the differences were statistically significant(P<0.05).Pearson correlation analysis showed that R and K were negatively correlated with FIB(r=-0.603,-0.6015,P<0.01),and thatαangle and MA were significantly and positively correlated with FIB(r=0.589,0.622,P<0.01).The AUC of R,K,αangle,MA,and FIB for predicting perioperative massive blood transfusion in patients undergoing general surgery was 0.755(95%CI:0.686 to 0.816),0.806(95%CI:0.741 to 0.861),0.752(95%CI:0.683 to 0.813),0.789(95%CI:0.723 to 0.846),and 0.807(95%CI:0.742 to 0.861);the Yoden index was 0.449,0.493,0.399,0.484,and 0.590,respectively;the optimal cut-off value was 7.45 min,3.41 min,47.62°,45.86 mm,1.46 g/L,respectively;the sensitivity was 73.33%,77.78%,80.00%,66.67%,and 91.11%,and the specificity was 71.53%,71.53%,59.85%,81.75%,and 67.88%,respectively.The AUC of the combined detection of the indicators for predicting perioperative massive blood transfusion in patients undergoing general surgery was 0.924(95%CI:0.875 to 0.958),which was better than that of each index alone.The risk of perioperative massive blood transfusion in patients un-dergoing general surgery with high R and K values was 4.201 times(95%CI:2.329 to 7.580)and 5.108 times(95%CI:2.700 to 9.663)as much as that in patients with low R and K values.The risk of perioperative blood transfusion in pa-tients undergoing general surgery with lowαangle,MA,and FIB values was 4.000 times(95%CI:2.047 to 7.818),4.618 times(95%CI:2.710 to 7.869),and 11.697 times(95%CI:4.370 to 31.307)as much as that in patients with highαangle,MA,and FIB values.Conclusion The combined application of TEG and FIB can provide a reference for predict-ing preoperative massive blood transfusion in patients undergoing general surgery,help doctors formulate corresponding blood transfusion schemes as early as possible,and thus improve prognosis.