血栓弹力图评估血小板功能有助于缩短患者冠状动脉搭桥术前等待时间  

Assessment of platelet function by thromboelastography can reduce the waiting time before coronary artery bypass grafting

作　　者：杨军[1] 刘晓辉[1] 李玲[1] 张李涛[1] 李然[1] 张晨彬[1] 陈晨[1] 张真路[1] 

机构地区：[1]武汉亚洲心脏病医院检验医学中心,430022

出　　处：《中华检验医学杂志》2017年第2期114-118,共5页Chinese Journal of Laboratory Medicine

摘　　要：目的：评估接受双联抗血小板（ DAPT）治疗后需进行冠状动脉旁路移植手术（ CABG）的患者使用血栓弹力图（ TEG）检测对患者手术时机选择的作用。方法前瞻性研究。选取2013年11月至2014年5月在武汉亚洲心脏病医院接受DAPT治疗后（阿司匹林100 mg／d，氯吡格雷75 mg／d）需实施CABG手术的急性冠状动脉综合征患者201例，年龄61．1±10．0（43～79）岁，男134例，女67例。并按1∶1比例随机分为两组。其中TEG组101例，均在术前停药后24 h使用ADP诱导血小板－纤维蛋白凝块强度（MAADP）的结果指导患者进行手术时机的选择，即MAADP分别为＞50 mm，35～50 mm和＜35 mm时，CABG分别在1 d内，3～5 d和5 d后完成。另外100例使用DAPT需实施CABG手术但未进行TEG检查的患者作为对照组（非TEG组）。对照组按常规停药5～7 d后手术。主要终点是术后24 h胸管引流量，次要终点是红细胞输入的总数。并记录患者插管时间，ICU停留天数，住院时间及30 d内不良事件发生率：如二次开胸，再次入院等。数据分析中分类变量使用Fisher进行计算，两组样本比较应用t－test。使用ANOVA进行变量因素的纠正，变量计数资料以百分率表示（％），统计分析应用卡方检验。结果通过TEG检测指导手术择期的患者及对照组的平均胸腔引流量分别为438．8 ml与487．8 ml（t＝1．063，P＝0．289），两组的红细胞输注总量为493．8 ml 与551．6 ml（t＝1．228，P＝0．223），差异均无统计学意义。 TEG组的术前平均等待时间是3．1 d，比指南推荐的5 d时间缩短了38％。结论 CABG手术前使用TEG检测血小板功能能够帮助患者选择手术时机，减少患者术前等待时间。而且患者术中及术后出血率和红细胞输注，以及术后不良事件的发生均没有增加。（中华检验医学杂志，2017，40：114－118）Objective To evaluate the effect of TEG （ thromboelastography ） in the timing choose of CABG（ coronary artery bypass grafting ） surgery for patients that receiving DAPT treatment .Methods This study is prospective analysis from November 2013 to May 2014 in Wuhan Asia Heart Hospital.The study cohort consisted of 1 201 patientswith acute coronary syndrome , theage range from 43 to 79 years （61.1 ±10 years） with 134 males and 79 females.and the patients undergo DAPT （ aspirin 100 mg/d, clopidogrel 75 mg/d） which were prepare to the coronary artery bypass grafting and then randomly divided into two groups according to the ratio of 1∶1.There were 101 patients, using perioperative TEG inspection , which conduct the choose of surgery timing according to the ADP-induced platelet-fibrin clot strength （ MAADP） after 24 h of the withdraw of DAPT.Distribute the patients into≥50 mm, 35-50 mm and 〈35 mm groups according to the MAADPresults, and theirCABG was complete within 1 day, 3-5 days and after 5 days respectively. The other 100 patientsacceptancoronary artery bypass grafting surgery and DAPT patients but without TEG examination as the control group , which were withdrawal the DAPT for 5 -7 days by routine before operation.The primary endpoint is 24 h chest tube drainage andkey secondary endpoint is the total number of transfused red blood cells .Recorded the mean intubation time , ICU stay times , Median length of hospital stayandrethoracotomyrates, 30-day mortality, and 30-day readmission rate at the same time.Using Fisher in＆amp;nbsp;the variables , t-test when two groups were compared , use ANCOVA for variable factor correction and Statistical analysis was performed using chi-square test in the calculate of results .Results The average chest drainage in TEG group and the control was 438.8 ml vs 487.8 ml（t=1.063,P=0.289）,and the total amount of transfused red blood cell in both groups were 493.8 ml vs 551.6 ml（t=1.228,P=0.2227）, there were no significant difference between the two g

关 键 词：冠状动脉分流术 血栓弹力描记术 血小板聚集 手术前期间 

分 类 号：R446.1[医药卫生—诊断学] R654.2[医药卫生—临床医学]