体外循环心脏手术患者血栓弹力图参数与凝血指标及血小板计数的相关性分析

Correlation analysis between thromboelastogram parameters and coagulation indexes,platelete count in patients undergoing cardiopulmonary bypass

目的分析体外循环心脏手术患者血栓弹力图(TEG)参数与凝血指标的相关性。方法回顾性分析2020年7月至2022年11月南阳市中心医院心脏外科收治的行体外循环心脏手术68例患者手术前后TEG检测、常规血凝血试验和血常规检测血小板计数(PLT),分析患者TEG检测中凝血反应时间(R)、血凝块形成时间(K)、血凝块形成速率(α)、最大振幅(MA)、凝血指数(BCI)、凝血酶原时间(PT),常规凝血指标中活化部分凝血时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TT)以及PLT之间的关系。结果68例患者手术前后TEG中R、K、α、BCI比较差异无统计学意义(P>0.05);术后MA值较术前降低(P<0.05)。患者术后PLT较术前降低,PT、APTT、Fib、TT水平较术前升高(P<0.05)。经Pearson相关性分析表明,TEG参数与凝血指标、PLT之间存在显著相关性,其中R与PT、K,K与PT、APTT,α与MA,MA与PLT均呈正相关(P<0.05),R与α、BCI,K与α、BCI、MA,α与PT、APTT,MA与APTT均呈负相关(P<0.05)。结论体外循环下的心脏手术患者TEG参数、凝血指标、PLT之间存在大量的相关关系,联合TEG、凝血试验能够更好的了解患者围手术期凝血功能,确保患者的安全。

【Objective】To analyze the correlation between thrombelastogram(TEG)parameters and coagulation indexes,platelet count(PLT)in patients undergoing cardiopulmonary bypass.【Methods】From July 2020 to November 2022,68 patients who underwent cardiopulmonary bypass heart surgery in Nanyang Central Hospital were retrospectively analyzed with TEG,routine blood coagulation test and PLT before and after surgery.The relationship among coagulation response time(R value),clot formation time(K value),clot formation rate(α),maximum amplitude(MA value),blood clotting index(BCI),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),thrombin time(TT)and PLT were analyzed.【Results】There was no significant difference in R value,K value,αangle and BCI in the thrombus elastogram of 68 patients before and after operation(P>0.05).The postoperative MA value was significantly lower than that before operation,and the difference was statistically significant(P<0.05).PLT decreased significantly after operation,while PT,APTT,Fib and TT levels increased significantly after operation,with statistical significance(P<0.05).Pearson correlation analysis showed that TEG parameters was significantly correlated with coagulation index and platelet count,in which R value was positively correlated with PT,K value,K value with PT,APTT,αangle with MA,MA with PLT;R value andαangle,BCI,K value andαangle,BCI,MA,αangle and PT,APTT,MA and APTT were negatively correlated(P<0.05).【Conclusion】There is a large correlation between thrombelastogram parameters,coagulation index and platelet count in patients undergoing cardiac surgery under cardiopulmonary bypass.The combination of thrombelastogram and coagulation test can better understand the perioperative coagulation function of patients and ensure the safety of patients.