血栓弹力图指导体外循环心脏手术围手术期输血对患者出血量、输血量和预后的影响  

Effect of thromboelastogram on blood loss,blood transfusion volume and prognosis in patients undergoing cardiopulmonary bypass surgery during perioperative period

作　　者：林升雄 曹一秋[1] 吴丹娜[1] 李儒正[1] LIN Sheng-xiong;CAO Yi-qiu;WU Dan-na(Department of Cardiac Surgery,Hainan Provincial People's Hospital,Haikou Hainan 570311,China)

机构地区：[1]海南省人民医院心脏外科,海南海口570311

出　　处：《临床和实验医学杂志》2021年第22期2413-2416,共4页Journal of Clinical and Experimental Medicine

基　　金：海南省医药卫生科研项目(编号:19A200055)。

摘　　要：目的研究血栓弹力图指导体外循环心脏手术围手术期输血对患者出血量、输血量和预后的影响。方法采用回顾性分析方法,以2020年1月至2021年1月海南省人民医院入院的80例择期体外循环心脏手术患者为研究对象,根据不同指导方式分为对照组(n=40)与研究组(n=40)。两组均于手术期间每次自体血液回输完成时、手术完成后24 h内引流量超过300 mL/h时测定血红蛋白(HB)水平,若HB低于70 g/L,即输注异体红细胞(RBC);对照组于上述时间节点测定常规凝血指标,研究组于上述时间节点测定血栓弹力图,根据测定结果输注纤维蛋白原(FIB)、血小板(PLT)及新鲜冰冻血浆(FFP)。记录两组患者围手术期输液量、输血量、出血量及相关药物使用情况与ICU停留时间、气管插管时间、住院时间、术后1 d内由于出血过多再次手术例数及病死例数。结果两组患者围手术期异体RBC输注量、自体血液、输液量、出血量与FIB、鱼精蛋白及氨甲环酸用量比较,差异无统计学意义(P>0.05);研究组围手术期PLT、FFP输注量为(512.16±71.34)、(310.28±61.42)mL,较对照组[(806.49±86.52)、(467.33±68.39)mL]更低,差异均有统计学意义(P<0.05);两组ICU停留时间、气管插管时间、住院时间、术后1 d内由于出血过多再次手术例数及病死例数比较,差异无统计学意义(P>0.05)。结论体外循环心脏手术围手术期输血中血栓弹力图指导作用显著,可有效降低患者PLT、FFP输注量,且对患者输血量、出血量及预后无不良影响。Objective To study the effect of thromboelastogram on blood loss,blood transfusion volume and prognosis of patients during perioperative blood transfusion during cardiopulmonary bypass.Methods Using retrospective analysis methods,80 cases of elective cardiopulmonary bypass cardiac surgery patients who admitted to Hainan Provincial People's Hospital from January 2020 to January 2021 were selected as the research objects.According to different guidance methods,they were divided into control group(n=40)and study group(n=40).In both groups,the hemoglobin(HB)level was measured every time the autologous blood reinfusion was completed during the operation and the drainage flow exceeded 300 mL/h within 24 hours after the operation was completed.If the HB was less than 70 g/L,the allogeneic red blood cells were infused(RBC);the control group measured routine coagulation indicators at the above time node,and the research group measured the thromboelastogram at the above time node,and infused fibrinogen(FIB),platelets(PLT)and fresh frozen plasma(FFP)according to the measurement results.The perioperative volume of infusion,blood transfusion,blood loss,and the use of related drugs,ICU stay time,tracheal intubation time,hospital stay,the number of reoperations due to excessive bleeding within 1 day after surgery,and the number of deaths were recorded in the two groups of patients.Results There was no statistically significant difference between the perioperative amount of allogeneic RBC infusion,autologous blood,infusion volume,and bleeding volume between the two groups of patients with FIB,protamine,and tranexamic acid(P>0.05).The infusion of PLT and FFP in the study group during the perioperative period were(512.16±71.34)and(310.28±61.42)mL,which were lower than those in the control group[(806.49±86.52),(467.33±68.39)mL],and the differences were statistically significant.Significance(P<0.05).The two groups'ICU stay time,tracheal intubation time,hospital stay,the number of reoperations due to excessive bleeding within 1 d

关 键 词：心脏手术 体外循环 围手术期输血 血栓弹力图 出血量 输血量 

分 类 号：R654.2[医药卫生—外科学] R459.1[医药卫生—临床医学]