血栓弹力图在指导化疗后肺癌患者临床用血中价值

Guiding function of thrombelastography on blood transfusion after chemotherapy in patients with lung cancer

目的探讨血栓弹力图(thrombelastography,TEG)对化疗后肺癌患者临床用血的指导作用。方法化疗后凝血功能异常需输血治疗的65例肺癌患者,随机分为TEG组29例和对照组36例,2组均于输血前和输血后24h检测凝血四项[包括凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,FIB)]和血小板计数(platelet count,PLT),TEG组同时行TEG检查。对照组采用凝血四项和血常规检查结果指导输血,TEG组采用TEG检查结果指导输血。比较2组输血前、后凝血四项和血常规指标,以及TEG组输血前、后TEG指标。结果 2组输血前PT、APTT、TT、FIB和PLT比较差异无统计学意义(P>0.05);TEG组输血后APTT[(32.51±6.27)s]、PT[(11.79±3.14)s]、TT[(19.28±3.18)s]低于输血前[(40.83±9.14)、(17.68±4.37)、(25.71±5.46)s](P<0.05),FIB[(2.91±0.93)g/L]和PLT[(125.41±53.78)×109/L]高于输血前[(1.35±0.48)g/L、(108.23±62.51)×109/L](P<0.05);对照组输血后APTT[(35.17±5.85)s]、PT[(13.62±3.54)s]、TT[(21.87±4.15)s]低于输血前[(41.52±8.65)、(17.24±4.81)、(25.13±4.35)s](P<0.05),FIB[(2.54±0.87)g/L]和PLT[(122.58±56.43)×109/L]高于输血前[(1.39±0.41)g/L、(113.72±61.83)×109/L](P<0.05);TEG组输血后PT、TT低于对照组(P<0.05),APTT、FIB和PLT与对照组比较差异无统计学意义(P>0.05);TEG组输血后凝血反应时间(R值)[(5.92±0.96)min]和凝血块形成时间(K值)[(3.07±0.81)min]低于输血前[(7.14±1.30)、(4.25±0.93)min](P<0.05),最大血凝块强度(MA值)[(56.84±10.27)mm]、血块形成速率(α角)[(65.23±12.96)°]和凝血综合指数(1.52±0.26)高于输血前[(45.37±9.62)mm、(54.72±11.53)°、-2.83±0.41](P<0.05);TEG组新鲜冰冻血浆[(136.27±41.32)mL]、冷沉淀[(3.24±1.35)u]输注量明显少于对照组[(164.13±47.35)mL、(4.57±1.62)u](P<0.05),血小板输注量[(4.76±2.47)u]与对照组[(5.61±2.83)u]比较差异无统计学意义(P>0.05)。结论与常规凝血功能检查相比,TEG检查能更好地指导化疗后肺癌患者各种血液成分的合理输注。

Objective To investigate the function of thromboelastography(TEG)on guiding blood transfusion after chemotherapy in patients with lung cancer.Methods Sixty-five lung cancer patients needing blood transfusion due to coagulation disorders after chemotherapy were randomly divided into TEG group(n=29)and control group(n=36).Two groups were detected prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)and platelet count(PLT)24hbefore and after blood transfusion,and TEG group received TEG.Control group received blood transfusion according to the blood test results and TEG received blood transfusion according to the TEG results.The blood parameters were compared before and after blood transfusion in both groups and TEG indexes were compared before and after TEG in TEG group.Results Before blood transfusion,there were no significant differences in the values of PT,APTT,TT,FIB and PLT between two groups(P>0.05).The values of APTT((32.51±6.27)s),PT((11.79±3.14)s)and TT((19.28±3.18)s)were significantly lower,and the values of FIB((2.91±0.93)g/L)and PLT((125.41±53.78)×109/L)were significantly higher after blood transfusion than those before blood transfusion((40.83±9.14)s,(17.68±4.37)s,(25.71±5.46)s,(1.35±0.48)g/L,(108.23±62.51)×109/L)in TEG group(P<0.05).The values of APTT((35.17±5.85)s),PT((13.62±3.54)s)and TT((21.87±4.15)s)were significantly lower,and the values of FIB((2.54±0.87)g/L)and PLT((122.58±56.43)×109/L)were significantly higher after blood transfusion than those before blood transfusion((41.52±8.65)s,(17.24±4.81)s,(25.13±4.35)s,((1.39±0.41)g/L,(113.72±61.83)×109/L)in control group(P<0.05).The values of PT and TT were significantly lower after blood transfusion in TEG group than those in control group(P<0.05),and there were no significant differences in APTT,FIB and PLT between two groups(P>0.05).In TEG group,the reaction time((5.92±0.96)min)and clot formation time((3.07±0.81)min)were significantly shorter,maximum clot strength((56.84±10.27)mm),clot formation rate((65.23±12.96)°)and coagulation index(1.52±0.26)were significantly higher after blood transfusion than those before blood transfusion((7.14±1.30),(4.25±0.93)min,(45.37±9.62)mm,(54.72±11.53)°,-2.83±0.41)(P<0.05).The volume of fresh frozen plasma((136.27±41.32)mL)and cryoprecipitate((3.24±1.35)u)were significantly less in TEG group than those in control group((164.13±47.35)mL,(4.57±1.62)u)(P<0.05),and there was no significant difference in the transfusion volume of PC between TEG group and control group((4.76±2.47)u vs(5.61±2.83)u)(P>0.05).Conclusion TEG is superior to routine coagulation tests in guiding the blood transfusion after chemotherapy in patients with lung cancer.