血栓弹力图评估腹部外科术后的输血量  

Clinical study on thromboelastography-indicated postoperative blood requirements after abdominal surgery

作　　者：张娟娟[1] 虞文魁[1] 高涛[1] 习丰产[1] 朱维铭[1] 李宁[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,南京210002

出　　处：《中华急诊医学杂志》2013年第8期885-890,共6页Chinese Journal of Emergency Medicine

摘　　要：目的术后出血是腹部外科围手术期常见的并发症之一，及时准确评估输血量对患苦的预后至关重要。本研究主要观察血栓弹力图（TEG）与生命体征、尿量、血红蛋白、红细胞压积等传统指标相比，能否准确评估输血量。方法观察2010年6月至2010年12月之间术后回监沪病房后怀疑有出血的57例患者。记录相关数据，包括生命体征（平均动脉压、心率、呼吸频率、球氧）、每小时尿量、血常规（Hb、Hct、Plt）、传统凝血试验指标（Fib、PT、aPTT、INR）、TEG参数（R、K、Angle、MA、CI）及术后有无出血、24h输血量。结果术后生命体征、小时尿量、血常规（Hb、Hct、Plt）、传统凝血试验（Fib、PT、INR）与输血量差异均无统计学意义，但是aPTT（R=0．513，P=0．000）和MA值（R=0．578，P=0．000）与输血量之间差异有统计学意义，其中MA值越低输血量越多。根据有无活动性出血将患者分为两组，活动性出血组和非活动性出血俎，两组MA值差异有统计学意义（P=0．025），而aPTT差异无统计学意义。结论TEG能准确洋估腹部术后出血的输血量，尤其是活动性出血。Objective To investigate the accuracy and promptness of thromboelastography （TEG） to assess the blood transfusion requirements after abdominal operation in comparison with conventional assessments including vital signs （MAP, heart rate, breathing rate）, urine output, hemoglobin and hematocrit. Methods From June to December in 2010, there were 57 patients were suspected bleeding in abdominal cavity after operation in SICU. Recorded data including vital signs （MAP, heart rate, breathing rate, oxygen saturation） , urine volume per hour, the coagulation tests （ Fib, PT, aPTT, INR ） , TEG parameters （R, K, Angle, MA, CI）, the results of blood routine （Hb, Hot, Ph） and whether bleeding or not , blood product requirements within 24 h. Results Vital signs （ MAP, heart rate, breathing rate, oxygen saturation）, urine output per hour and the coagulation tests （Fib, PT, INR） showed no significant correlations （ P 〉 0. 05 ） with blood transfusion requirements, but aPTT （ R = 0. 513, P = 0. 000） and MA （R =0. 578, P =0. 000） correlated with the blood transfusion requirement. Patients with reduced MA needed more blood transfusion requirements. Patients were divided into active bleeding group and insidious bleeding group. MA had significant difference between two groups （P = 0. 025 ） , but aPTT had not. Conclusions Thrombelastography is a more accurate indicator of blood transfusion requirements, especially in active bleeding patients.

关 键 词：血栓弹力图 传统凝血试验 腹部外科 出血 活动性出血 输血 输血量 

分 类 号：R656[医药卫生—外科学]