TEG/ROTEM对肝硬化静脉曲张出血患者出血量预测及指导备血的价值  

A study on TEG/ROTEM in predicting the bleeding amount and for guiding blood preparation in liver cirrhotic patients with variceal bleeding

作　　者：魏鹂娴 邵晨 罗蕾蕾 何红梅 徐姝嫣 施玲灵 顾浩然 朱陈 陈建[1] 卞兆连[1] WEI Li-xian;SHAO Chen;LUO Lei-lei;HE Hong-mei;XU Shu-yan;SHI Ling-ling;GU Hao-ran;ZHU Chen;CHEN Jian;BIAN Zhao-lian(Jiangsu province Nantong Third People’s Hospital Department of Gastroenterology,Jiangsu,226001,China;Jiangsu province Nantong Third People’s Hospital Department of Gastroenterology,Jiangsu 226001,China)

机构地区：[1]南通大学附属南通第三医院消化内科,江苏226001 [2]南通市第六人民医院胸普外科

出　　处：《肝脏》2023年第11期1301-1305,共5页Chinese Hepatology

基　　金：南通市卫生健康委员会青年课题(QA2021040);南通市卫生健康委员会青年课题(QA2021041)。

摘　　要：目的探讨TEG/ROTEM对肝硬化静脉曲张出血患者出血量预测及指导备血的价值。方法选择2021年7月—2022年10月在南通大学附属南通第三医院诊治的食管胃底静脉曲张破裂出血(EVB)患者100例,依随机分组软件随机均匀分为实验组和常规组,每组人数各50例。常规组和实验组分别予以传统凝血指标(CCTs)指导输血和血栓弹力图参数(TEG)指导输血。观察输血前后凝血指标的差异、血液制品用量和预后情况。结果两组间红细胞悬液(CRC)使用量的差异较小(t=3.244,P>0.05);实验组新鲜冰冻血浆(FFP)、血小板悬液(PC)和冷沉淀(CRYO)的输入量均显著小于常规组(t=6.866,8.335,10.256,P<0.05);常规组在进行治疗的过程中需要注输2种血液制品的患者的人数显著高于实验组(χ^(2)=12.245,P<0.05),并且常规组在治疗过程中无需输注相关血制品的患者的人数显著小于实验组(χ^(2)=8.051,P<0.05)。另外,常规组在执行治疗的阶段出现输血反应的患者人数显著高于实验组(χ^(2)=9.256,P<0.05),所有患者的输血反应为轻微输血反应,未发生心功能衰竭、溶血、休克等严重输血反应。在对患者进行治疗前,两组患者的凝血相关指标水平接近,差异无统计学意义(P>0.05),治疗后患者的凝血指标相关表现更良好,指标前后改善水平明显(P<0.05)。常规组的凝血功能相关指标相关数值较实验组更低,表明实验组患者凝血指标的改善情况明显更优(P<0.05)。而两组的止血成功率、再出血率、死亡率、肝性脑病和腹水发生率差异均无统计学意义(χ^(2)=0.762,0.271,1.010,0.211,0.298,P<0.05)。结论与常规凝血指导输血相比,TEG/ROTEM指导的输血方案可显著减少血液制品的用量,且不会降低止血成功率和升高再出血率、死亡率、肝性脑病及腹水的发生率,值得临床推广。Objective To explore the value of thromboelastogram(TEG)/rotational thromboelastometry(ROTEM)in predicting the bleeding amount of cirrhotic patients with esophageal variceal bleeding(EVB)and for guiding the study of blood preparation.Methods One hundred patients with EVB who were diagnosed and treated in our hospital from July 2021 to October 2022 were randomly divided into an experimental group and a conventional group according to the random grouping software,with 50 patients in each group.The conventional group and the experimental group were given traditional common caugulation tests(CCTs)guidance and TEG guidance respectively.The difference of coagulation index,blood product dosage and prognosis before and after transfusion were observed.Results There was little difference in the amount of concentrated red blood cells(CRC)between the two groups(t=3.244,P>0.05);The input of fresh frozen plasma(FFP),Platelet concentrates(PC)and cryoprecitation(CRYO)in the experimental group were significantly lower than those in the conventional group(t=6.866,8.335,10.256,P<0.05);The number of patients in the routine group who need to inject two kinds of blood products during treatment was significantly more than that in the experimental group(χ^(2)=12.245,P<0.05),and the number of patients in the routine group who do not need to inject related blood products during treatment was significantly less than that in the experimental group(χ^(2)=8.051,P<0.05).In addition,the number of patients with blood transfusion reaction in the conventional group was significantly more than that in the experimental group(χ^(2)=9.256,P<0.05).The blood transfusion reaction of all patients was slight,and no severe blood transfusion reaction such as heart failure,hemolysis,shock occurred.Before treatment,the levels of coagulation related indicators of patients in the two groups were similar,without statistical difference(P>0.05).After treatment,the coagulation related indicators of patients were significantly improved,(P<0.05).The related values

关 键 词：TEG/ROTEM 肝硬化静脉曲张出血 出血量预测 

分 类 号：R575.2[医药卫生—消化系统]