TEG指导剖宫产术中大出血输血治疗的效果和安全性  

Effect and Safety of Blood Transfusion for Massive Hemorrhage during Cesarean Section Guided by TEG Results

作　　者：郑剑锋[1] 周群[1] 彭永保[1] ZHENG Jianfeng;ZHOU Qun;PENG Yongbao(Jiangxi Maternal and Child Health Hospital,Nanchang 330006,China;不详)

机构地区：[1]江西省妇幼保健院,江西南昌330006

出　　处：《中国医学创新》2023年第4期26-30,共5页Medical Innovation of China

基　　金：江西省重点研发计划项目(20202BBGL73066);江西省卫生与健康委员会科技计划项目(202130836)。

摘　　要：目的:探讨应用血栓弹力图(TEG)指导剖宫产术中大出血输血治疗的效果和安全性。方法:回顾性分析2020年5月-2021年11月江西省妇幼保健院收治的64例剖宫产术中出血量≥1000 mL且进行了成分输血的产妇的临床资料,根据术中输血指导方式的不同分为对照组(n=28)和TEG组(n=36)。对照组根据出血量、简易试管法结果及结合医生经验和输血指南指导凝血物质输注,TEG组则根据术中间断TEG检测结果指导凝血物质输注。比较两组产妇术前和术毕凝血相关指标、术中出血量、血制品输注量、术后ICU住院时长和术后总住院时长。结果:两组术前和术毕的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、血小板计数(PLT)、血红蛋白(Hb)、术中出血量、异体红细胞输注量、纤维蛋白原输注量、术后ICU住院时长和术后总住院时长比较,差异均无统计学意义(P>0.05)。TEG组术中血浆、冷沉淀、血小板的输注量分别为(555.8±152.2)mL、(3.11±0.65)U、(2.88±0.61)U,少于对照组的(671.3±174.0)mL、(3.92±0.82)U、(3.73±0.66)U,差异均有统计学意义(P<0.05)。结论:应用TEG来指导剖宫产术中大出血输血治疗可以减少血浆、冷沉淀和血小板的用量,且不会对产妇的术后康复带来不利影响。Objective:To explore the effect and safety of blood transfusion therapy in cesarean section with massive hemorrhage under the guidance of thromboelastogram(TEG).Method:The clinical data of 64 parturients with blood loss≥1000 mL and component transfusion during cesarean section admitted to Jiangxi Maternal and Child Health Hospital from May 2020 to November 2021 were retrospectively analyzed,and they were divided into control group(n=28)and TEG group(n=36)according to the guidance methods of intraoperative blood transfusion.Procoagulant substance infusion in the control group was guided by the amount of bleeding,the results of simple test tube method,doctor's experience and blood transfusion guidelines,procoagulant substance infusion in the TEG group was guided by the results of TEG detection during surgery.The blood clotting indexes before and after surgery,intraoperative blood loss,blood product infusion,length of postoperative ICU stay and total postoperative hospital stay were compared between the two groups.Result:There were no significant differences in prothrombin time(PT),activated partial thrombin time(APTT),fibrinogen(FIB),platelet count(PLT),hemoglobin(Hb),intraoperative blood loss,allored blood cell infusion,fibrinogen infusion,postoperative length of ICU stay and total postoperative length of stay between the two groups(P>0.05).The intraoperative infusion volumes of plasma,cryoprecipitate and platelet in the TEG group were(555.8±152.2)mL,(3.11±0.65)U and(2.88±0.61)U respectively,which were lower than(671.3±174.0)mL,(3.92±0.82)U and(3.73±0.66)U in the control group,the differences were statistically significant(P<0.05).Conclusion:Using TEG to guide the blood transfusion during cesarean section with massive hemorrhage can reduce the dosage of plasma,cryoprecipitate and platelet,and has no adverse effect on the postoperative rehabilitation.

关 键 词：剖宫产 成分输血 血栓弹力图 凝血功能 

分 类 号：R719.8[医药卫生—妇产科学] R457.1[医药卫生—临床医学]