血栓弹力图评估肺癌患者围手术期凝血状态的临床研究  

Clinical analysis on perioperative blood coagulation status in lung cancer patients by thrombelastography

作　　者：曾小飞[1] 邓波[1] 王如文[1] 周景海[1] 郭伟[1] 牛会军[1] 马铮[1] 康珀铭[1] 陶绍霖[1] 谭群友[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所全军胸外科研究所,重庆400042

出　　处：《第三军医大学学报》2016年第7期766-770,共5页Journal of Third Military Medical University

摘　　要：目的应用血栓弹力图(thrombelastogram,TEG)评估肺癌患者围手术期凝血状态。方法选择2014年我科接受手术治疗肺部疾病患者170例,分为肺癌组(100例)与良性疾病组(70例)。观察术前TEG的R、K、Angel、MA、CI参数,比较肺癌组和良性疾病组TEG的差异。结果与良性疾病组比较,肺癌组TEG的R值和K值明显缩短(P<0.01),Angel、MA和CI值明显增宽(P<0.01),而常规凝血功能除FIB有所升高外(P<0.01),其他指标差异均无统计学意义(P>0.05);肺癌组Ⅲ期与Ⅰ期、Ⅱ期比较,TEG各参数差异有统计学意义(P<0.01);有淋巴结转移(N1-3)与无淋巴结转移者(N0)比较,K、Angel、MA值差异有统计学意义(P<0.05);肺癌组8例术后出现下肢静脉血栓,其中有症状者3例,下肢静脉血栓阳性组与阴性组术前TEG各参数差异有统计学意义(P<0.05),肺部良性疾病组无病例出现静脉血栓。结论肺癌患者血液处于高凝状态,其高凝状态与分期和淋巴结转移呈正相关;与常规凝血功能相比,TEG更能全面、准确地反映体内凝血状态。Objective To assess the blood coagulation status of lung cancer patients during perioperative period by thrombelastography（ TEG）. Methods A total of 170 patients with pulmonary diseases and undergoing surgery treatment in our hospital during January and December 2014 were enrolled in this study. They were divided into benign disease group（ n = 70） and lung cancer group（ including adenocarcinoma and squamous cell carcinoma,n = 100）. The parameters of TEG,including R,K,Angel,MA and CI,were recorded to compare the differences between the benign disease group and lung cancer group. Results Compared with the benign group,the R and K values of TEG were significantly smaller in lung cancer group（ P 〈 0. 01）,while,those of MA and CI had adverse trends（ P 〈 0. 01）. Nevertheless,in regular blood coagulation function evaluation,only fibrinogen（ FIB） had significant difference between benign disease group and lung cancer group（ P 〈 0. 01）. Moreover,the TEG parameters were significantly different in between the lung cancer patients at stage Ⅲ and stagesⅠ or Ⅱ（ P 〈 0. 01）. Additionally,K value,Angel and MA in the cases with lymphatic metastasis were remarkably different compared with those without（ P 〈0. 05）. There were 8 patients had postoperative thrombus of lower extremity veins,and 3 of them represented symptomatic lesions. Significant differences were seen in the TEG parameters between the 8 patients and those without thrombus（ P 〈 0. 05）. There was no vein thrombosis occurred in the benign disease group.Conclusion The blood of lung cancer patients is in a hypercoagulable state,which is positively correlated with staging and lymphatic metastasis. Compared with regular blood coagulation function inspection,TEG more accurately reflects the blood coagulation status.

关 键 词：血栓弹力图 肺肿瘤 围手术期 凝血状态 

分 类 号：R331.11[医药卫生—人体生理学] R444[医药卫生—基础医学]