血栓弹力图用于外科术后患者凝血状态的精准监测价值  

The Precise Value of The Accurate Monitoring Value of Thromboelastogram Used for Coagulation Status of Patients After Surgery

作　　者：张娟[1] 贺元[1] 李焱鑫[1] 赵太强[1] Zhang Juan;He Yuan;Li Yanxin(Department of Laboratory Medicine,Sichuan Provincial People′s Hospital,Chengdu,Sichuan 610041,China)

机构地区：[1]四川省人民医院检验科,四川成都610041

出　　处：《四川医学》2020年第8期848-853,共6页Sichuan Medical Journal

摘　　要：目的评价血栓弹力图(thromboelastogram,TEG)监测外科术后患者凝血状态的临床价值。方法收集我院2018年10月至2019年5月进行了外科手术治疗且术后48 h均进行了TEG检测的患者资料(199例)和同期进行了TEG检测的正常对照组资料(222例),收集TEG的凝血反应时间(R值)、凝血形成时间(K值)、凝固角(Angle,α值)、血栓最大振幅(MA值)、MA确定后30 min内纤维蛋白溶解率(LY30)、凝血指数CI(coagulation index,)参数结果。根据病例组诊断的不同,分为肺癌术后组(60例)、肝癌术后组(50例)、肾移植术后组(47例)和食道癌术后组(42例),采用t检验和方差分析比较正常组与各病例组的TEG参数是否有差异。结果正常对照组和病例组总体在R、K、α和CI差异有统计学意义(P<0.05);与正常对照组比较,肝癌及肾移植术后组R小于对照组(P=0.000),食管癌术后组及肾移植术后组K小于对照组(P=0.001),α大于对照组(P=0.000),CI大于对照组(P=0.001)且肾移植术后组EPL小于对照组(P=0.048)。肺癌术后组差异无统计学意义(P>0.05)。进行性别分组后,男性患者的R值、K值、α值、MA值和CI值与正常对照组相比差异有统计学意义(P<0.05),而女性患者差异无统计学意义(P>0.05)。结论外科术后应用TEG能监测患者的高凝状态及预判血栓动态形成;相较于肺癌术后患者,应用TEG监测肝癌、食道癌和肾移植术后男性患者的凝血功能价值更高,但仍需扩大样本进行验证。Objective To evaluate clinical value of thromboelastogram( TEG) in monitoring coagulation status of patients after surgery.Methods Patients’ data from October 2018 to May 2019 in our hospital that underwent surgical treatment and TEG test at 48 hours after surgery as case group( n = 199) and that underwent TEG test as normal control group( n = 222) were collected.TEG coagulation reaction time( R value),coagulation time( K value),coagulation angle( Angle,α value),maximum thrombus amplitude( MA value),fibrinolysis rate within 30 minutes after MA determination( LY30),coagulation Index( CI) were collected.According to different diagnosis of case groups,they were divided into lung cancer postoperative group( n = 60),liver cancer postoperative group( n= 50),kidney transplantation postoperative group( n= 47) and esophageal cancer postoperative group( n= 42).The t test and ANOVA were used to compare whether TEG parameters between normal group and each case group were different. Results There were significant differences in R,K,α and CI between normal control group and case group( P < 0. 05). Compared with normal control group,in liver cancer postoperative and kidney transplantation postoperative group,R values were lower( P = 0. 000),K values were smaller( P = 0. 001),α values were greater( P = 0. 000),CI were greater( P = 0. 001),and EPL of kidney transplantation postoperative group was smaller( P = 0. 001).There was no significant difference in lung cancer postoperative groups( P>0. 05).After gender grouping,R,K,α,MA and CI value of male patients were significantly different from those of normal control group( P<0. 05),while differences in female patients were not statistically significant( P>0. 05).Conclusion The application of TEG after surgery could monitor the patients’ hypercoagulable state and predict the dynamic formation of thrombosis. Compared with lung cancer postoperative patients,it could be more valuable that TEG was used to monitor coagulation function of male patients with liver cancer,esophageal

关 键 词：血栓弹力图 外科术后 凝血状态 血栓形成 

分 类 号：R446.11[医药卫生—诊断学]