血栓弹力图在评价重症多瓣膜病患者围术期凝血功能中的应用  

Application of thrombelastogram in the evaluation of perioperative coagulation function in patients with severe multi-valvular diseases

作　　者：杨旭[1] 马润伟[1] 宋怡[1] 王霁阳[1] 张晓羽[1] 甘延清[1] 张大勇 

机构地区：[1]云南省第二人民医院,昆明650021

出　　处：《临床心血管病杂志》2017年第10期991-995,共5页Journal of Clinical Cardiology

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项(No:2014FZ045)

摘　　要：目的:探讨血栓弹图(TEG)在重症多瓣膜病患者术后凝血功能评估及指导成分输血、术后抗凝中的意义。方法:回顾性分析近5年成功进行手术治疗的62例重症多瓣膜病患者,对比术前和术后1h和48h各项TEG检测参数及传统血常规和凝血机制检测参数,并将术后1h各项参数与术后输注血浆、血小板和冷沉淀量进行相关性分析。结果:术后1h的R值和K值明显延长(P<0.05),术后1h的α-Angle值和MA值明显减小(均P<0.05),血常规显示术后1h血小板(PLT)计数明显降低(P<0.05),传统的凝血项检测纤维蛋白原(FIB)术后1h明显降低(P<0.05),部分活化凝血酶原时间(APTT)、凝血酶原时间(PT)和INR值术后1h均明显延长(均P<0.05)。Ly30(%)在手术后1h升高(P<0.05),术后48h较术后无显著差异。术后血浆输注量与R值有显著相关性(P<0.05),血小板输注量与MA和PLT计数有显著相关性(均P<0.05),冷沉淀输注量与K值、α-Angle和APTT有显著相关性(均P<0.05)。结论:TEG可提示重症多瓣膜病手术患者术后的凝血功能障碍,R值可以指导血浆的输注,MA值可以指导血小板的输注,K值、α-Angle可以作为术后冷沉淀输注的重要参考,Ly30(%)在手术后1h升高提示继发性纤溶功能亢进,术后48h较术后无显著差异,提示患者凝血功能恢复,应给予华法林等抗凝药物,预防血栓形成。Objective：To evaluate the significance of thrombelastogram（TEG）in assessing coagulation function and guiding blood component transfusion and choosing anticoagulation in postoperative patients with severe multi-valvular diseases.Method：Sixty-two patients with severe multi-valvular diseases who received successful operation in the last five years were retrospectively analyzed.TEG detection parameters,conventional blood and coagulation testing parameters were compared among the time points of preoperative,1hand 48 hof postoperative.The correlation analysis was performed between the parameters of 1hafter operation and postoperative transfusion of plasma,including platelet and cryoprecipitate.Result：The R value and K value were significantly prolonged at1hpostoperatively（P〈0.05）.The values ofα-Angle and MA were significantly decreased at 1hpostoperatively（P〈0.05）.Blood routine showed platelet counts was significantly reduced at 1hpostoperatively（P〈0.05）.Traditional coagulation tests showed FIB was significantly reduced at 1hpostoperatively（P〈0.05）.The values of APTT,PT and INR were significantly prolonged at 1hpostoperatively（P〈0.05）.Ly30（%）elevated at 1h postoperatively（P〈0.05）,and there was no significant difference between the 48 hafter operation and postoperative.The postoperative plasma transfusion was significantly correlated with R value（P〈0.05）.The postoperative platelet transfusion was significantly correlated with MA and platelet counts（both P〈0.05）.The postoperative cryoprecipitate transfusion was significantly correlated with the values of K,α-Angle and APTT（both P〈0.05）.Conclusion：TEG could suggest the dysfunction of blood coagulation after surgical operation in patients with severe multi-valvular diseases.The R value could guide the plasma transfusion.The MA value could guide the platelet transfusion.Theα-Angle and K value could be used as an important reference for cryoprecipitate transfusion.Ly30（%）elevated at 1hpostoperativel

关 键 词：血栓弹力图 重症多瓣膜病 围术期 成分输血 

分 类 号：R654.2[医药卫生—外科学]