血栓弹力图指导下肝硬化患者三腔中心静脉置管的临床应用  

Clinical analysis on thromboelastograms guidance for three lumen central venous catheter in patients with liver cirrhosis

作　　者：赵佳平[1] 侯米莎[1] 胡海立[1] 

机构地区：[1]首都医科大学附属北京地坛医院麻醉科,北京100015

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第3期83-85,共3页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的观察肝硬化合并肾功能衰竭、伴凝血异常的患者应用血栓弹力图(TEG)监测在中心静脉置管中的临床应用。方法选择肝硬化合并肾功能衰竭、伴凝血功能异常的患者共40例,经颈内静脉穿刺置入三腔静脉导管,随机分成两组,每组各20例。对照组(A组)患者根据实验室凝血检测结果常规输注血浆和血小板;治疗组(B组)患者根据TEG监测结果输注血浆和血小板。同时观察两组病例穿刺后TEG的变化、伤口渗血以及感染情况。结果两组患者穿刺后TEG测定反应时间(R)、凝血酶形成时间(K)、最大振幅(MA)和α角值差异均具有统计学意义(P均<0.05),采用TEG监测治疗的患者伤口出血减少,且局部感染率降低。结论肝硬化患者通过TEG监测数据及时纠正血液低凝状态,可减少伤口出血和感染,同时可对肝硬化患者进行有创诊治提供帮助。Objective To investigate application ofthromboelastography （TEG） monitoring for patients of liver cirrhosis complicated with renal failure, coagulation abnormalities catheterization. Method Total of 40 patients with renal failure, liver cirrhosis and coagulation abnormalities were selected for central venous catheterization through internal jugular vein by three cavity catheter. These 40 patients were randomly, divided into two groups with 20 patients in both groups. Group A infused plasma, and/or platelet according to the coagulation test results. Group B infused plasma, and/or platelet according to the monitoring result of TEG. Wound bleeding, wound infection and TEG results after puncture in both groups were recorded and compared. Results Group B with TEG monitoring treatment had less wound bleeding and infection, whth statistically significance （P 〈 0.05）. Conclusions According to TEG results, patients with liver cirrhosis could be treated in time, and with less wound bleeding and infection. TEG could be helpful to diagnosis and treatment afterwards.

关 键 词：肝硬化 血栓弹力图 三腔静脉置管 出血 感染 

分 类 号：R575.2[医药卫生—消化系统]