血栓弹力图在围手术期骨折患者凝血功能监测中的应用  

Application of Thrombelastogram in Monitoring Coagulation Function of Patients with Fracture During Peri-operative Period

作　　者：张艳红 郑山根 张宇[1] 熊洲 寇国梅 刘磊 ZHANG Yanhong;ZHENG Shangen;ZHANG Yu;XIONG Zhou;KOU Guomei;LIU Lei(Department of Transfusion,Wuhan First Hospital,Wuhan Hubei 430022,China)

机构地区：[1]武汉市第一医院输血科,湖北武汉430022 [2]中部战区总医院输血科

出　　处：《华南国防医学杂志》2020年第5期306-309,313,共5页Military Medical Journal of South China

基　　金：湖北省卫生健康委科研联合项目(WJ2018H0070,WJ2019H092)。

摘　　要：目的探讨血栓弹力图(thrombelastogram,TEG)在围手术期骨折患者凝血功能监测中的临床意义。方法选取2019-01~06月在中部战区总医院骨科住院并需行手术治疗的150例骨折患者作为研究对象,并依据骨折部位不同分为5组。应用TEG和传统凝血功能监测患者手术前后的凝血功能变化,分析术后TEG参数与传统凝血功能指标的相关性,探讨手术前后不同骨折部位分组间TEG参数改变的差异。结果与术前相比,术后患者TEG指标血形成时间(K)值显著降低,凝固角(α)值、血栓最大振幅(MA)值显著升高(P<0.01),凝血反应时间(R)值无明显变化(P>0.05);传统凝血功能参数纤维蛋白原(fibrinogen,Fg)显著升高(P<0.01),凝血酶原时间(prothrombin time,PT)、活化部分凝血时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)及血小板计数等均无显著改变(P>0.05)。TEG检测与传统凝血功能检测相关性分析表明,MA值与Fg成正相关(r=0.20,P<0.05),其它TEG参数与传统凝血功能指标间均无相关性(P>0.05)。不同骨折部位手术前后K值、α值改变量差异均具有统计学意义(P<0.05),而R值、MA值手术前后的改变量差异均无统计学意义(P>0.05)。结论TEG应用于围手术期骨折患者凝血功能的监测临床意义显著,脊柱骨折和多发骨折的患者更需关注术后凝血功能的动态监测,有助于降低深静脉血栓等并发症的发生风险。Objective To investigate the clinical significance of thrombelastogram(TEG)in monitoring coagulation function of patients with fracture during peri-operative period.Methods A total of 150patients with fracture in the department of orthopaedics of General Hospital of Central Theater Command from January to June 2019were selected as the subjects.According to different fracture sites the patients were divided into five groups.The coagulation function of patients were monitored by TEG and traditional coagulation function before and after operation.The relationship between the TEG index and the traditional coagulation function index after operation was analyzed,the difference of the TEG indexes before and after operation between the different fracture sites groups were discussed.Results Compared with before operation,the K value of the TEG index of patients was significantly decreased after operation,and the values ofαand MA were significantly higher(P<0.01),while the R value had no significant change(P>0.05);the traditional coagulation function parameter fibrinogen(Fg)was significantly increased(P<0.01),while the values of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and platelet count were not significantly changed(P>0.05).In the correlation analysis between TEG and traditional coagulation function,MA value was positively correlated with Fg(r=0.20,P<0.05),the other TEG indexes were not correlation with traditional coagulation function indexes(P>0.05).The changes of values of K andαbefore and after operation in different fracture sites groups were significantly different(P<0.05),but there were no significant differences in the changes of values of R and MA(P>0.05).Conclusion The clinical significance of TEG in monitoring coagulation function of patients with fracture during peri-operative period is significant.Pa-tients with spinal fracture and multiple fracture need to pay more attention to the dynamic monitoring of coagulation function after operation to reduce the risk of com

关 键 词：血栓弹力图 传统凝血功能 骨折患者 手术创伤 

分 类 号：R683[医药卫生—骨科学]