血栓弹力图在非体外循环冠状动脉移植术中置入主动脉球囊患者安全性和有效性研究  

Safety and efficacy of thromboelastography in patients undergoing intraaortic balloon implantation during OPCAB

作　　者：张海涛[1] 韦薇 汤楚中[3] 王磊[1] 李岩 冯增斌[1] Zhang Haitao;Wei Wei;Tang Chuzhong;Wang Lei;Li Yan;Feng Zengbin(Department of Cardiourgery,Affiliated Hospital of Chengde Medical College,Chengde 067000,Hebei Province,China)

机构地区：[1]承德医学院附属医院心脏外科,067000 [2]承德医学院附属医院血液检验室 [3]解放军总医院第六医学中心心脏外科

出　　处：《中华老年心脑血管病杂志》2022年第5期480-482,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：承德市科学计划项目(202006A032)。

摘　　要：目的 探讨血栓弹力图(TEG)相关参数与非体外循环冠状动脉旁路移植术(OPCAB)中置入主动脉内球囊反搏患者围术期输血及引流量的相关性。方法 选择2016年1月~2021年10月承德医学院附属医院心脏外科收治的行择期OPCAB患者317例,其中术中置入主动脉内球囊反搏患者100例,使用随机数字表法分为传统常规凝血指标指导组(CCT组)及TEG指标指导组(TEG组),每组50例。比较2组患者术后血制品输注种类和使用量以及术后24 h纵隔和胸腔液体总引流量的差异。结果 TEG组血小板、新鲜冰冻血浆、冷沉淀使用量较CCT组明显减少[(1.62±0.37)U vs(1.88±0.54)U,P<0.05;290.0(227.5,300.0)ml vs 500.0(300.0,600.0)ml,P<0.01;(13.89±4.29)U vs(26.74±2.79)U,P<0.01]。TEG组术后24 h纵隔和胸腔液体总引流量较CCT组明显减少[(302.50±31.35)ml vs(552.50±28.30)ml,P<0.01]。结论 TEG相关指标用于指导OPCAB中置入主动脉内球囊反搏患者成分输血可显著提高治疗的有效性。同时可减少术后出血,提高临床治疗的安全性。Objective To study the relationship of TEG parameters with perioperative blood transfusion and drainage volume in patients who underwent intraaortic balloon implantation during OPCAB.Methods Of the 317 patients admitted to our hospital for elective OPCAB,100 who underwent intraaortic balloon implantation during OPCAB were randomly divided into TEG group(n=50) and conventional coagulation traditional index-guided(CCT) group(n=50).The types and transfusion volumes of blood products, and the total mediastinal and thoracic fluid drainage volume at 24 h after OPCAB were compared between the two groups.Results The platelet volume, fresh frozen plasma volume and cryoprecipitate volume in treatment of the patients were significantly smaller in TEG group than in CCT group [1.62±0.37 U vs 1.88±0.54 U,P<0.05;290.0(227.5,300.0) ml vs 500.0(300.0,600.0) ml, P<0.01;13.89±4.29 U vs 26.74±2.79 U,P<0.01].The total drainage volume of mediastinal and thoracic fluid was significantly smaller in TEG group than in CCT group at 24 h after OPCAB(302.50±31.35 ml vs 552.50±28.30 ml, P<0.01).Conclusion TEG parameters-guided blood transfusion can effectively improve the effectiveness of blood transfusion, reduce the postoperative bleeding volume and increase the safety of clinical treatment in patients undergoing intraaortic balloon implantation during OPCAB.

关 键 词：血栓弹力描记术 冠状动脉旁路移植术 非体外循环 主动脉内气囊泵 输血 围手术期 

分 类 号：R654.2[医药卫生—外科学]