血栓弹力图在指导A型主动脉夹层围手术期个体化成分输血中的应用价值分析  

Application value of thromboelastography in the guidance of perioperative indi⁃vidualized component blood transfusion for patients with type A aortic dissection

作　　者：张壮丽[1] 李辉[2] 王东[2] 胡佳 陈晓红 鞠丽丽 Zhang Zhuangli;Li Hui;Wang Dong;Hu Jia;Chen Xiaohong;Ju Lili(Cardiothoracic Surgery Intensive Care Unit,Linfen People's Hospital,Shanxi Linfen 041000,China)

机构地区：[1]山西临汾市人民医院胸心外科监护室,临汾041000 [2]山西临汾市人民医院心脏大血管外科,临汾041000

出　　处：《中国体外循环杂志》2022年第6期340-344,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨血栓弹力图(TEG)在StanfordA型主动脉夹层围手术期个体化成分输血的指导价值。方法选择2017年1月至2021年12月在临汾市人民医院经过手术治疗的StanfordA型主动脉夹层患者患者74例,按照是否行TEG检查和个体化成分输血分为TEG组(n=40例)和对照组(n=34例)。TEG组根据检测结果指导临床成分输血,对照组经验性输血治疗。收集TEG组个体化成分输血前和输血后的TEG各项检测指标,TEG组和对照组患者手术指标;术中和术后输血量、凝血功能并进行比较。结果TEG组个体化成分输血前后TEG各项检测指标比较,干预后较干预前各项指标明显改善(P<0.05);血小板计数、凝血酶原时间、部分凝血活酶时间、纤维蛋白原干预后较干预前明显改善(P<0.05)。手术时间和术中出血量两组相比,TEG组明显低于对照组(P<0.05);术中输血量:悬浮红细胞、血浆、冷沉淀、血小板两组相比,TEG组明显低于对照组(P<0.05);两组患者术后24h内输血浆量、悬浮红细胞、24h内引流量、总引流量相比,TEG组明显低于对照组(P<0.05)。术中体外循环时间、停循环时间、术后ICU和总住院时间、呼吸机治疗时间、死亡率均无明显差异(P>0.05);二次开胸止血发生率TEG组明显低于对照组(P<0.05)。结论基于血栓弹力图制定个体化成分输血是科学、合理的,在减少出血并发症的同时还能够大量节约血液资源。Objective To explore the guiding value of thromboelastography(TEG)in perioperative individualized component blood transfusion for patients with Stanford type A aortic dissection.Methods 74 patients who underwent surgery for Stanford type A aortic dissection in Linfen people's Hospital from January 2017 to December 2021 were selected and divided into TEG group(n=40 ca⁃ses)and control group(n=34 cases)according to whether received TEG examination and individualized component blood transfusion or not.TEG group recieved clinical component blood transfusion according to the TEG test results,and the control group received em⁃pirical blood transfusion treatment.TEG test indexes before and after individualized component transfusion in TEG group,the operation indexes of patients in TEG group and control group(operation time,cardiopulmonary bypass time,circulatory arrest time and blood loss),and intraoperative and postoperative blood transfusion volume(red blood cell volume,blood plasma volume,platelet volume and cryoprecipitate volume)and coagulation function(PLT,PT,APTT,FIB)were collected and compared.Results The comparison of TEG indexes before and after individual component transfusion in TEG group showed that after the intervention,the indexes were signif⁃icantly improved compared with those before intervention(P<0.05);PLT,PT,APTT and FIB were significantly improved after inter⁃vention(P<0.05).The operation time and intraoperative blood loss in TEG group were significantly lower than those in control group(P<0.05).Intraoperative blood transfusion volume(suspended red blood cells,plasma,cryoprecipitation and platelets)in TEG group was significantly lower than that in control group(P<0.05).The volume of blood transfusion plasma,suspended red blood cells,drainage volume and total drainage volume within 24 hours in TEG group were significantly lower than those in control group(P<0.05).There was no significant difference in cardiopulmonary bypass time,circulatory arrest time,postoperative ICU stay,total hospital st

关 键 词：主动脉夹层 体外循环 血栓弹力图 并发症 出血 输血 心脏手术 

分 类 号：R654.3[医药卫生—外科学] R457.1[医药卫生—临床医学]