自体血回输对神经外科手术患者血栓弹力图的影响  

Effects of autologous blood transfusion on thrombelastography in patients underwent neurosurgery

作　　者：张杰 张瑚敏 王文秀 张德明[2] 周述芝[2] ZHANG Jie;ZHANG Humin;WANG Wenxiu;ZHANG Deming;ZHOU Shuzhi(Department of Anesthesiology of North Sichuan Medical College,Nanchong 631000,China;Yaran Peopled Hospital)

机构地区：[1]川北医学院麻醉学系,四川南充637000 [2]雅安市人民医院

出　　处：《中国输血杂志》2021年第7期732-735,共4页Chinese Journal of Blood Transfusion

基　　金：2016年雅安市科技局科研课题(2016yyjsykf008)。

摘　　要：目的探讨术中自体血回输(ABT)对神经外科手术患者血栓弹力图(TEG)的影响。方法回顾性分析2018年11月~2020年11月本院行神经外科手术并术中输血的患者病例96例(男49例,女47例),年龄15~79岁,并根据术中输血方式分为自体血回输组(A组,n=52)和异体输血组(B组,n=44)。对比2组患者输血量情况、术前和术后1d血红蛋白(Hb)、红细胞压积(Hct)、血小板(Plt)、纤维蛋白原(Fib)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)及TEG参数[凝血激活时间(ACT)、凝集时间(K)、血凝块形成速率(Angle)、血凝块最大强度(MA)]的变化。结果 2组患者的平均输血量(mL)差异无统计学意义(P>0.05),A组补充异体血输注率17.3%(9/52),A组平均异体血输注量明显低于B组(333.3±81.7 vs 639.8±258.2)(P<0.05)。2组患者术前的Hb、Hct、Plt、Fib、PT、APTT、ACT、K、MA和Angle水平差异无统计学意义(P>0.05);术后1d, A组患者的Hb(g/L)(109.4±15.8 vs 97.0±15.1)、Hct (%)(32.0±4.3 vs 28.3±6.1)、Plt(×10^9/L)(154.2±54.2 vs 120.7±41.6)、Fib(g/L)(2.2±0.5 vs 1.6±0.6)、MA(mm)(65.0±7.2 vs 60.7±8.7)和Angle水平(deg)(69.1±5.2 vs 62.6±9.8)明显高于B组(P<0.05),A组患者的PT(s)(11.9±1.5 vs 12.8±0.9)、APTT(s)(27.4±3.3 vs 30.4±5.4)、ACT(s)(111.0±14.9 vs 119.1±12.3)和K(min)(87.2±25.7 vs 106.4±28.0)水平明显低于B组(P<0.05)。结论术中自体血回输可减少神经外科手术患者异体血输注,对凝血功能和血栓弹力图影响小,安全有效。Objective To explore the effects of intraoperative autologous blood(ABT)transfusion on thrombelastography(TEG)in patients underwent neurosurgical procedures.Methods 96 patients(49 males and 47 females)aged 15~79 years who received neurosurgical procedures in our hospital from November 2018 to November 2020 were retrospectively analyzed and divided into autologous blood transfusion group(Group A,n=52)and allogeneic blood transfusion group(Group B,n=44)according to different blood transfusion strategy in operation.The red blood transfusion status,hemoglobin(Hb),hematocrit(Hct),platelet(Plt),fibrinogen(Fib),prothrombin time(PT),activated partial thromboplastin time(APTT),and TEG parameters[activated clotting time(ACT),coagulation time(K),angle rate of clot formation(Angle),maximum amplitude(MA)]before and 1 day after surgery were compared between the two groups.Results The amount of average blood transfusion didn′t differ significantly by groups(P>0.05).The incidence of extra allogeneic blood transfusion was 17.3%(9/52)in group A,and the amount of average allogeneic blood transfusion in group A was significantly lower than that in group B(333.3±81.7 vs 639.8±258.2,P<0.05).Before operation,the differences in Hb,Hct,Plt,Fib,PT,APTT,ACT,K,MA and Angle levels between the 2 groups were not statistically significant(P>0.05).One day after operation,the Hb(g/L)(109.4±15.8 vs 97.0±15.1),Hct(%)(32.0±4.3 vs 28.3±6.1),Plt(×10^(9)/L)(154.2±54.2 vs 120.7±41.6),Fib(g/L)(2.2±0.5 vs 1.6±0.6),MA(mm)(65.0±7.2 vs 60.7±8.7)and Angle levels(deg)(69.1±5.2 vs 62.6±9.8)in group A were significantly higher than those in group B(P<0.05),and the PT(s)(11.9±1.5 vs 12.8±0.9),APTT(s)(27.4±3.3 vs 30.4±5.4),ACT(s)(111.0±14.9 vs 119.1±12.3)and K levels(min)(87.2±25.7 vs 106.4±28.0)in group A were significantly lower than those in group B(P<0.05).Conclusion Intraoperative ABT in patients underwent neurosurgical procedures can reduce allogeneic blood transfusion,has less effect on coagulation function and TEG,and is safe and e

关 键 词：自体血回输 神经外科手术 凝血功能 血栓弹力图 

分 类 号：R457.1[医药卫生—治疗学] R651[医药卫生—临床医学]