血栓弹力图监测重症肝硬化消化道出血患者凝血功能变化的临床价值  

Clinical value of thromboelastography in monitoring coagulation function change in patients with severe lever cirrhosis gastrointestinal bleeding

作　　者：贺荣 伍民生[1] 陈盛奎[1] 刘品晶[1] 李军[1] 潘俞丹 胡炳全 HE Rong;WU Minsheng;CHEN Shengkui;LIU Pinjing;LI Jun;PAN Yudan;HU Bingquan(Department of Intensive Care Medicine,Affiliated Ruikang Hospital,Guangxi University of Chinese Medicine,Nanning,Guangxi 530000,China)

机构地区：[1]广西中医药大学附属瑞康医院重症医学科,南宁530000

出　　处：《重庆医学》2024年第18期2735-2738,2743,共5页Chongqing Medical Journal

基　　金：广西壮族自治区卫生健康委员会计划课题(Z20211563)。

摘　　要：目的探讨血栓弹力图(TEG)在监测重症肝硬化消化道出血患者补充血浆后的凝血功能变化中的临床价值。方法选取2020年2月至2022年3月在该院重症医学科接受治疗的48例肝硬化急性上消化道出血高危及极高危患者为研究对象,以10 mL/kg输注血浆后检测凝血功能状态,根据凝血功能检测方式的不同分为TEG组(n=20)和对照组(n=28),TEG组同时进行TEG和传统凝血功能检测,对照组只进行传统凝血功能检测。比较两组输注血浆后TEG、凝血功能检测指标,统计入住ICU 24 h血浆输注量并评估消化道出血控制状态。结果TEG组R值为(8.02±6.09)min,K值为2.5(1.3,5.0)min,凝血综合指数(CI)为-4.70±6.29,最大切应力系数(MA)为50.35±18.84,LY30为0。Pearson相关性分析结果显示,MA与纤维蛋白原(FIB)、PLT呈正相关(r=0.470、0.526,P<0.05),其余指标无相关性。与对照组比较,TEG组血浆输注量[(419.00±143.18)mL vs.(400.00±137.54)mL]更多,消化道出血控制率[75.00%(15/20)vs.53.57%(15/28)]更高,但差异无统计学意义(P>0.05)。多重线性回归方程为MA=-3.427+11.200×Ln(PLT)+10.230×Ln(FIB)。结论对于重症肝硬化急性上消化道出血患者,TEG较传统凝血功能检测能更早发现患者补充血浆后的凝血功能改善情况。Objective To investigate the clinical value of thromboelastography(TEG)in monitoring the coagulation function change after plasma supplementation in the patients with severe liver cirrhosis digestive tract hemorrhage.Methods A total of 48 patients with high risk and extreme high risk liver cirrhosis acute upper digestive hemorrhage receiving the treatment in ICU of this hospital from February 2020 to March 2023 were selected as the study subjects.After plasma infusion with the dose of 10 mL/kg,the coagulation function status was detected.The patients were divided into the TEG group(n=20)and the control group(n=28)according to different detection modes of coagulation function.The TEG group simultaneously detected TEG and traditional coagulation function detection,while the control group only conducted the traditional coagulation detection.TEG and coagulation function detection indicators after the infusion of plasma were compared between the two groups.The plasma infusion amounts at 24 h after admitting in ICU were recorded and the control status of digestive tract hemorrhage was evaluated.Results The R value in the TEG group was(8.02±6.09)min,the K vale was 2.5(1.3,5.0)min,the coagulation comprehensive index(CI)was-4.70±6.29,the maximal shear stress coefficient(MA)was 50.35±18.84,LY30 was 0.The Pearson correlation analysis showed that MA was positively correlated with FIB and PLT(r=0.470,0.526,P<0.05),and the other indexes had no correlation.Compared with the control group,the plasma infusion amounts in the TEG group was more[(419.00±143.18)mL vs.(400.00±137.54)mL],the digestive tract hemorrhage control rate was higher[75.00%(15/20)vs.53.57%(15/28)],but the differences were not statistically significant(P>0.05).The multiple linear regression was MA=-3.427+11.200×Ln(PLT)+10.230×Ln(FIB).Conclusion In the patients with severe lever cirrhosis acute upper gastrointestinal bleeding,TEG could earlier find the coagulation function improvement situation after plasma supplementation than the traditional coagulation

关 键 词：肝硬化 急性上消化道出血 凝血功能 血栓弹力图 输血 

分 类 号：R575.2[医药卫生—消化系统]