血栓弹力图监测体外循环心脏手术患者凝血功能的价值分析

Analysis of the Value of Thrombelastography for Monitoring Coagulation Function in Patients Undergoing Cardiac Surgery with Extracorporeal Circulation

目的:分析血栓弹力图(TEG)监测体外循环心脏手术患者凝血功能的价值。方法:选取2023年1月—2024年1月拟于上海医大医院重症医学科接受体外循环心脏手术的患者82例作为研究对象。所有患者均在术前、术中、术后24 h进行TEG检测,分析TEG对凝血功能异常的诊断价值。结果:术中、术后,体外循环心脏手术患者凝血块绝对强度、α角低于术前,凝固时间长于术前(P<0.05);各时间段凝血反应时间比较,差异无统计学意义(P>0.05)。凝血六项检测结果显示,82例患者中共有42例术中出现血小板减少,发生率为51.22%。α角的受试者操作特征曲线下面积最大(AUC=0.805,P<0.05),敏感度为78.6%,特异度为67.5%。结论:TEG监测能及时评估体外循环心脏手术患者凝血功能,其中α角为敏感参数,对临床预测出血及有效输血具有重要参考价值。

Objective:To analyze the value of thrombelastography(TEG)for monitoring coagulation function in patients undergoing cardiac surgery with extracorporeal circulation.Methods:Eighty-two patients who were to undergo extracorporeal circulation cardiac surgery in the Department of Critical Care Medicine of Shanghai Yida Hospital from January 2023 to January 2024 were selected as the study subjects.All patients underwent TEG testing before,during and 24 h after surgery to analyze the diagnostic value of TEG on coagulation abnormality.Results:Intraoperatively and postoperatively,the absolute strength andα-angle of clots in patients undergoing extracorporeal circulation cardiac surgery were lower than that of preoperative,and the coagulation time was longer than that of preoperative(P<0.05);the comparison of coagulation reaction time in each time period showed that the difference was not statistically significant(P>0.05);the results of the six items of coagulation test showed that a total of forty-two of the eighty-two patients had thrombocytopenia in the course of operation,with an incidence rate of 51.22%;theα-angle had the largest area under the receiver operating characteristic curve(AUC=0.805,P<0.05),with a sensitivity of 78.6%and a specificity of 67.5%.Conclusion:TEG monitoring can timely assess the coagulation function of patients undergoing extracorporeal circulation cardiac surgery,withα-angle as a sensitive parameter,which is an important reference value for clinical prediction of bleeding and effective blood transfusion.