血栓弹力图在评价膝关节置换患者术后下肢深静脉血栓形成的临床价值研究  

Study on evaluation of phlebothrombosis by thrombelastogram in knee prosthesis replacement

作　　者：孙辉[1] 臧学慧[1] 高立华[1] 谭永滔 

机构地区：[1]南方医科大学附属南海医院骨科,佛山528200

出　　处：《中华关节外科杂志（电子版）》2015年第2期17-20,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨血栓弹力图(TEG)在评价膝关节置换术后下肢深静脉血栓形成的价值。方法收集本组2010年3月至2013年9月行人工膝关节置换术患者116例,分别于麻醉前(T0)、手术开始后2h(T1)、术后第1天(T2)和术后第3天(T3)采集患者静脉血进行TEG检测,采用重复测量方差分析比较两组患者各采集点时TEG的R、K、α、MA、G和CI等6个参数值。结果患者在围手术期间均呈现高凝状态,且表现为进行性加重。与各指标正常值比较,膝关节置换术患者TEG指标中R和K缩短,α角、MA以及G值增大,CI增大与麻醉前T0比较,R值逐渐下降,其中T2和T3时的R下降显著;K值也成逐渐下降趋势,但不具统计学差异;α角、MA以及G值则显著性升高;CI无显著性变化。TEG诊断对照组患者深静脉血栓的准确性为66.67%,观察组患者深静脉血栓诊断准确性为77.78%,卡方检验表明差异无统计学意义(P>0.05)。结论 TEG是判断行膝关节置换手术患者围手术期血液高凝状态的敏感指标之一,值得临床推广。Objective To discuss the method and values of thrombelastogram（ TEG） in the patients undergoing knee prosthesis replacement. Methods One hundred and sixteen patients who underwent knee prosthesis replacement in our hospital from March 2010 to September 2013 were collected.The venous blood of the patients were collected for thrombelastogram before anaesthesia（ T0）,2 h after the operation（ T1）,one day（ T2） and three days（ T3） after the operation. The parameters of TEG including R,K,α,MA,G and coagulation composite index（ CI） were compared among these time points. Results All the patients presented hypercoagulabale state during the perioperative period and aggravated progressively. Compared with normal values, R and K values were shorten, α, MA and G values increased; CI also increased. Compared with T0,R value decreased,especially at T2 and T3; K value decreased slowly with no significant difference; α and MA signicantly increased; the difference in CI showed no statistical significance. The diagnostic accuracy of TEG for deep vein thrombosis was 66. 67% in the control group while it was 77. 78% in the observation group; the chi-square test showed the difference was not significant（ P〉0. 05）. Conclusion TEG could effectively determine blood hypercoagulabale state of the patients in the perioperative period and it is worthy of clinical application.

关 键 词：血栓弹力描记术 关节成形术  置换  膝 静脉血栓形成 

分 类 号：R687.4[医药卫生—骨科学]