血栓弹力图在肝硬化患者围术期的应用  

Application of thrombelastogram monitoring during operation in patients with cirrhosis

作　　者：陈家华[1] 廖建梅[1] 殷国平[1] 张建[1] 王佳[1] 

机构地区：[1]南京市第二医院麻醉科,210003

出　　处：《江苏医药》2005年第11期827-829,共3页Jiangsu Medical Journal

摘　　要：目的评价肝炎肝硬化手术患者术中血栓弹力图(TEG)监测的临床意义。方法45例乙型肝炎肝硬化患者与30例肝功能正常者进行TEG监测,肝硬化患者随机分为两组:22例用凝血酶原复合物600PE、纤维蛋白原1.0g、血小板10单位静脉输注(治疗组);未经治疗的23例(对照组)。比较麻醉前、手术后TEG主要参数及红细胞比容、手术时间和术中出血量。结果与肝功能正常者比较,肝硬化患者麻醉前TEG参数有异常变化:R和K时间明显延长(P<0.05);α角、MA、G和CI均显著降低(P<0.01);CI>+3者0例,α角、MA无一例异常增大;Ly30均在正常范围。与麻醉前比,治疗组术后R明显缩短(P<0.05),α角和MA值显著增大(P<0.01)。对照组术后R明显延长(P<0.05);α角和MA值均明显降低(P<0.05);治疗组术中出血量显著少于对照组(P<0.01)。结论肝硬化患者麻醉前TEG监测反映血液低凝状态;经针对性治疗,术后TEG提示低凝状态被逆转。肝硬化患者围手术期TEG监测可为治疗提供重要依据。Objective To evaluate the clinical significance of thrombolastogram（TEG） monitoring during operation in patients with cirrhosis. Methods TEG monitoring was carried out in 45 patients（group A） with cirrhosis after type B virus hepatitis and 30 cases（group N） with normal liver function tests. The patients in group A were divided into two subgroups. The patients in group T（n=22） were treated with thrombinogen complex 600PE, fibrinogen 1.0g and platelet 10U, and those in group C（n=23） were not. TEG, Hct, operation time, and bleeding during operation were recorded and compared between group T and C. Results Compared with those in group N, the time of TEG R and K prolonged（P〈0.05）,a angle, MA, G and CI decreased （P〈0. 01） in groupT. There was no any patient in group T with CI〉＋3, and abnormal change in a angle, MA value, and Ly30. Compared with those before anesthesia, R on TEG was shorter（P〈0.05）, a angle and MA value increased （P〈0. 01） in group T,and R on TEG was prolonged（P〈0.05） and a angle and MA values were decreased（P〈0.05） in group C. The amount of bleeding was markedly less in group T than that in group C. Conclusion TEG monitoring in patients with cirrhosis reflected preoperative hypoeoagulation status, which was improved by proper treatments. TEG monotoring may provide an important indication in treating preoperative coagulation abnormality in patients with cirrhosis.

关 键 词：血栓弹力图 肝硬化 围术期 麻醉处理 凝血机能障碍 

分 类 号：R575.2[医药卫生—消化系统]