心外术后采用血栓弹力图监测指导输血对心功能、凝血功能的影响

Effect of monitoring and guiding blood transfusion by TEG on cardiac function and coagulation function

目的分析心外术后采用血栓弹力图(TEG)监测指导输血对心功能、凝血功能的影响。方法回顾性纳入医院2021年4月—2023年5月收治的100例行心外科手术治疗患者为研究对象,根据不同指导输血方式将其划分为对照组(常规心功能、凝血功能监测指导输血)与研究组(TEG监测指导输血),每组患者50例,分析输血前、输血24 h后对研究组患者TEG相关参数[凝血反应时间(R值)、凝血形成时间(K值)、凝血形成速率(α角)、凝血最大强度(MA)、凝血综合指数(CI)]的变化情况,比较不同指导模式下研究组与对照组间输血前及输血24 h后的心功能[左室收缩期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)]及凝血功能[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、凝血酶时间(TT)]。结果①研究组采用TEG指导输血24 h后,TEG指标K、R更低,α、MA、CI更高,差异有统计学意义(P<0.05);②输血前研究组与对照组间LVEDD、LVESD、LVEF比较,差异无统计学意义(P>0.05),输血24 h后,研究组与对照组LVEDD、LVESD均降低,LVEF均升高,组间比较差异有统计学意义(P<0.05),但研究组LVEF高于对照组,LVEDD、LVESD低于对照组,组间比较差异有统计学意义(P<0.05);③输血前研究组与对照组间TT、PT、APTT、FIB比较差异无统计学意义(P>0.05),输血24 h后,研究组及对照组TT、PT、APTT均下降,FIB均上升,组间比较差异有统计学意义(P<0.05),但研究组TT、PT、APTT低于对照组,FIB高于对照组,组间比较差异有统计学意义(P<0.05)。结论相较于传统凝血功能监测模式,TEG能实现动态实时监测,心外术后采用TEG监测指导输血能显著提升患者的心功能水平、改善患者凝血功能,保障心外术后患者输血的安全性,建议临床推广使用。

Objective To analyze the effect of guiding blood transfusion on cardiac function and coagulation function.Methods A total of 100 patients admitted to cardiac surgery in our hospital from April 2021 to May 2023 were retrospectively included as the study object.According to different guiding blood transfusion methods,they were divided into control group(routine cardiac function and coagulation function monitor guide blood transfusion)and research group(thrombelastogram[TEG]monitor guide blood transfusion),of the 50 patients in each group.The TEG parameters of the study group were analyzed before and 24h after transfusion.The parameters were compared between study and control groups,including cardiac function(left ventricular end-diastolic diameter[LVEDD],left ventricular end-systolic diameter[LVESD],left ventricular ejection fraction[LVEF])and coagulation function(prothrombin time[PT],activated partial thromboplastin time[APTT],fibrinogen[FIB],thrombin time[TT]).Results①The study group performed TEG for 24 h after guiding blood transfusion,lower TEG indicators K,R,α,MA,and higher CI,statistically significant difference(P<0.05);②There was no statistical significance of LVEDD,LVESD and LVEF between the study group and the control group(P>0.05).After 24 h of blood transfusion,LVEDD and LVESD in the study group and the control group were both decreased,LVEF were both increased,there were statistical significance between the groups(P<0.05).However,LVEDD and LVESD in the study group were lower than those in the control group,the LVEF in the study group was higher than that in the control group,and there were statistically significant between the groups(P<0.05).③There was no statistical significance of TT,PT,APTT and FIB between the study group and the control group(P>0.05).After 24 h of blood transfusion,TT,PT and APTT decreased in the study and control groups,FIB both increased,and there was statistically significant difference(P<0.05).However,TT,PT and APTT in the study group were lower than those in the control group,FIB was higher than that in the control group,and there was statistically significant between the groups(P<0.05).Conclusion Compared with the traditional coagulation function monitoring mode,TEG guiding blood transfusion could realize dynamic real-time monitoring,significantly improve the cardiac function level and coagulation function of patients,and ensure the safety of blood transfusion in patients after extracardiac surgery.