血栓弹力图在膝关节镜手术预防下肢肌间静脉血栓中的应用  

Clinical application of thromboelastography in the prevention of lower extremity intermuscular venous thrombosis after knee arthroscopy

作　　者：张中清 乔姝 吴麦拉苏 迟浩楠 王平平 孙金磊[2] ZHANG Zhongqing;QIAO Shu;WU Mailashu;CHI Haonan;WANG Pingping;SUN Jinlei(Graduate School,Inner Mongolia University of Science and Technology Baotou Medical College,Baotou 014040,China;Department of Joint and Sports Medicine,Inner Mongolia University of Science and Technology;Department of Blood Transfusion,The First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology)

机构地区：[1]内蒙古科技大学包头医学院研究生院,内蒙古包头014040 [2]内蒙古科技大学包头医学院第一附属医院关节与运动医学一科,内蒙古包头014040 [3]内蒙古科技大学包头医学院第一附属医院输血科,内蒙古包头014040

出　　处：《中国输血杂志》2024年第6期625-631,共7页Chinese Journal of Blood Transfusion

基　　金：内蒙古自治区自然科学基金项目(2021MS08052);内蒙古自治区卫生健康科技计划项目(202202236);包头医学院青年科技人才发展计划项目(BYJJ-DXK 2022036)。

摘　　要：目的探究血栓弹力图(thromboelastography,TEG)对膝关节镜术后个性化抗凝方案制定的指导价值。方法选择2023年4—8月在本院关节科行膝关节镜手术患者50名,随机分组,常规抗凝27例为对照组,个性化抗凝23例为试验组。常规抗凝是指按体重选择对应剂量,用预防剂量的低分子肝素钙(low molecular weight heparin calcium,LMWHC)进行抗凝,1次/d至术后7 d;个性化抗凝按预防剂量LMWHC抗凝至术后d3,术后d3根据TEG回报指标(MA>70 mm、α角>72°、K值<1 min时,将LMWHC改为阿司匹林,初始预防剂量为100 mg/d;R<5min时将LMWHC改为利伐沙班,预防剂量为10 mg/d至术后d7)。出现低凝或皮下瘀斑患者先停药,若进一步加重,根据TEG回报指标成分性输血。比较2组围手术期Caprini评分的差异性、术后d1的TEG和CCT相关性、根据术后d7血栓发生情况,应用受试者工作特征曲线(ROC)分析2组预测血栓形成准确度的差异。结果2组在术后7 d Caprini评分有显著差异(P<0.05),提示术后3 d试验组调整抗凝药物有效。Pearson相关性评价显示术后d1时TEG中的凝血最大强度(MA)和CCT中血小板计数(Plt)具有强正向相关性(P<0.05)。术后d7对照组中有血栓形成,均为小腿肌间静脉血栓(calf muscular venous thrombosis,CMVT),经治疗性抗栓后消失。将作为差异指标的MA纳入ROC曲线中进行模型分析,对照组ROC曲线下面积(AUC)为0.819,试验组AUC为0.508,发现对照组模型预测形成CMVT的准确度更高。结论TEG监测下个性化抗凝有效减少膝关节镜术后CMVT的发生,对抗凝预防血栓具有指导价值。Objective To explore the guiding value of thromboelastography(TEG)in the formulation of personalized anticoagulation regimen after knee arthroscopy.Methods A total of 50 patients who underwent knee arthroscopy in our hospital from April to August 2023 were randomly divided into two groups.Twenty-seven patients with routine anticoagulation were selected as the control group,and 23 patients with personalized anticoagulation were selected as the experimental group.Conventional anticoagulation was a prophylactic dose of low molecular weight heparin calcium(LMWHC)selected according to body weight,once a day to 7 days after surgery.Personalized anticoagulation was performed according to the prophylactic dose of LMWHC until postoperative day 3.On postoperative day 3,LMWHC was changed to aspirin according to the TEG return index(MA>70 mm,αAngle>72°,K value<1 min),and the initial prophylactic dose was 100 mg/d.LMWHC was changed to rivaroxaban when R<5 min,and the prophylactic dose was 10 mg/d until postoperative day 7.Patients with hypocoagulation or subcutaneous ecchymosis stopped the drug first,and if it was further aggravated,component blood transfusion was performed according to the TEG results.The difference of Caprini score in perioperative period,the correlation between TEG and CCT on postoperative day 1,and the accuracy of predicting thrombosis on postoperative day 7 were compared between the two groups using the receiver operating characteristic curve(ROC).Results There was a significant difference in Caprini score between the two groups at 7 days after operation(P<0.05),suggesting that the adjustment of anticoagulant drugs in the experimental group was effective at 3 days after operation.Pearson correlation evaluation showed that there was a strong positive correlation between maximum coagulation intensity(MA)in TEG and platelet(Plt)in CCT at day 1 after surgery(P<0.05).Thrombosis was found in the control group at 7 days after operation,all of which were CMVT and disappeared after therapeutic antithrombotic th

关 键 词：血栓弹力图 个性化抗凝 膝关节镜 肌间静脉血栓 

分 类 号：R457.1[医药卫生—治疗学] R364.15[医药卫生—临床医学] R543.6