血栓弹力图指导围手术期临床输血的应用价值

Application Study of Thromboelastogram in Guiding Clinical Blood Transfusion in Perioperative Patients

目的建立血栓弹力图联合凝血常规检测围手术期患者的输血方案,以便合理有效的指导临床输血。方法选择预计术中出血量>1000m L的患者70名,随机分为实验组和对照组,每组35名。实验组采用血栓弹力图联合凝血常规检测结果指导输血,对照组采用传统的凝血常规检测结果指导输血,统计失血量、输血量等指标。结果实验组患者术前、术后1和24h血中血红蛋白(Hb)、红细胞压积(Hct)、血小板(PLT)凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平与对照组比较差异均无统计学意义(P均>0.05)。实验组血栓弹力图各指标术前、术中输血前后及术后24h比较差异有统计学意义(P<0.05)。实验组患者使用红细胞悬液,新鲜冰冻血浆、血小板、冷沉淀使用量均低于对照组(P均<0.01)。结论血栓弹力图和凝血常规联合检测有助于指导围手术期患者输血方案的优化,尤其是对成分输血的选择明显优于常规输血评估指标。

Objective To establish the reasonable and effective blood transfusion program based on cooperative detection of TEG and coagulation routine of perioperative patients. Methods Seventy patients,of which predetermined amount of blood transfusion were more than 1,000 milliliters,were randomized into 2 groups in1∶1 ratio as Conditional control group and experimental group. In experimental group(n=35),coagulation assessment was performed using TEG and routine coagulation. In control group,choosing conventional methodsperformed the coagulation assessment. The amount of total blood loss volume and blood transfusion volume were collected as index in this study. Results The indexes of TEG in experimental group were significantly different among preoperative,intraoperative before and after transfusion,24 hours after operation(P<0.05).The usage amount of red cell suspension,fresh frozen plasma and blood platelet during intraoperative blood transfusion and postoperative blood transfusion in experimental group were significantly less than that of the control group(P<0.01). Conclusion The combined detection of TEG and coagulation routine are very useful in establishing reasonable blood transfusion program for perioperative patients. TEG monitoring plays a significantly important role in coagulation assessment of transfusion of plasma,platelet and cryoprecipitate. TEG is an effective method in guiding clinical transfusion.