术中大量输血对恶性肿瘤患者血栓弹力图和凝血功能的影响  

The effect of large intraoperative blood transfusion on thrombuselastography and coagulation in patients with malignant tumors

作　　者：张春丽[1] 牛梦林[1] 吴寒[1] 孙巍[1] Zhang Chunli;Niu Menglin;Wu Han;Sun Wei(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Department of Blood Transfusion,Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所输血科恶性肿瘤发病机制及转化研究教育部重点实验室

出　　处：《北京医学》2019年第10期932-934,共3页Beijing Medical Journal

摘　　要：目的观察恶性肿瘤患者术中大量输血前后血栓弹力图(thromboelastography,TEG)与凝血功能各指标的变化,评估输血量对其的影响。方法选择2015年6月至2017年12月北京大学肿瘤医院择期手术的大量输血患者51例,按输红细胞量分为3组,8~15 U组(22例)、16~25 U组(17例)、26 U以上组(12例),检测各组输血前及输血后的TEG参数与常规凝血指标。结果51例患者输血后的PT、INR、APTT较输血前明显延长,FIB与TEG参数中血细胞凝集块形成时间(K)、血细胞凝集块形成速率(Angle)、血凝块最大强度(MA)较输血前显著减少,差异均有统计学意义(P<0.05)。输血前,3组FIB比较,差异有统计学意义(P<0.05);输血后,3组APTT、K、Angle、MA比较,差异均有统计学意义(P<0.05)。3组输血后的Angle、MA值与输血前比较差异均有统计学意义;8~15 U组与16~25 U组的K值输血前后差异有统计学意义(P<0.05)。结论术中大量输血的恶性肿瘤患者常伴有凝血功能紊乱,应及时检测凝血指标,补充血液成分和血液制品。Objective To observe the change of thromboelastography(TEG)and coagulation function indexes after intraoperative massive blood transfusion in patients with malignant tumor,and to evaluate the effect of blood transfusion amount on them.Methods Fifty-one patients with intraoperative massive blood transfusion in Peking University Cancer Hospital&Institute from June 2015 to December 2017 were selected.According to the amount of erythrocyte transfusion,the patients were divided into three groups:8-15 U group(22 patients),16-25 U group(17 patients),and above 26 U group(12 patients).The TEG and coagulation function indexes were tested before and after blood transfusion.Results The PT,INR and APTT of 51 patients after transfusion were significantly longer than those before transfusion.FIB and K,Angle and MA of TEG parameters were significantly lower than those before transfusion(P<0.05).There were significant differences in FIB before transfusion among the three groups(P<0.05).After transfusion,there were significant differences in APTT,K,Angle and MA among the three groups(P<0.05).The angle and MA after transfusion were significantly different with those before transfusion in each group.And K of 8-15 U group and 16-25 U group after transfusion were significantly different with those before transfusion(P<0.05).Conclusions Patients with malignant tumors undergoing massive intraoperative blood transfusion are often accompanied by coagulation dysfunction.Coagulation indicators should be detected in time to supplement blood components and blood products.

关 键 词：恶性肿瘤 大量输血 血栓弹力图 凝血功能检测 

分 类 号：R73[医药卫生—肿瘤]