血栓弹力图与常规凝血功能检查在肝衰竭治疗中的作用  

The Role of Thromboelastography and Routine Coagulation Function Test in the Treatment of Liver Failure

作　　者：苏双报 张晓琳 陈宝婷[1] 吴耀建 SU Shuangbao;ZHANG Xiaolin;CHEN Baoting;WU Yaojian(Department of the Blood Transfusion,the 910th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Quanzhou Fujian 362000,China;Department of Disease Prevention and Control,the 910th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Quanzhou Fujian 362000,China)

机构地区：[1]中国人民解放军联勤保障部队第九一〇医院输血科,福建泉州362000 [2]中国人民解放军联勤保障部队第九一〇医院疾病预防控制科,福建泉州362000

出　　处：《中国卫生标准管理》2024年第18期92-95,共4页China Health Standard Management

摘　　要：目的分析肝衰竭患者采取血浆置换(plasma exchange therapy,PE)及连续性血液净化(continuous blood purification,CBP)治疗中,开展血栓弹力图(thromboelastography,TEG)、常规凝血功能检查对其治疗的影响。方法选取2022年1月—2023年10月在中国人民解放军联勤保障部队第九一〇医院治疗的220例肝衰竭患者。以术前综合评估结果为依据,将采取PE治疗的90例患者纳入对照组,将采取CBP治疗的130例患者纳入观察组。在患者治疗过程中,2组定期开展常规凝血功能检查,作为治疗方案效果的评估依据,观察组还进行TGE评估。对比2种检测方法的应用效果。结果治疗后,经TEG检查,观察组凝血反应时间(reaction time,R)、血细胞凝集块形成速率(angle,α角)、最大凝固幅度(maximum amplitude,MA)、凝血指数(coagulation index,CI)分别为(7.8±2.6)min、(44.1±10.4)°、(37.8±7.4)mm、(-6.7±1.5),均优于治疗前的(11.8±3.2)min、(37.2±9.5)°、(34.0±8.5)mm、(-10.6±1.6),差异有统计学意义(P<0.05)。治疗后,经常规凝血功能检查,观察组凝血时间(prothrombin time,PTA)、国际标准化比值(international normalized ratio,INR)、纤维蛋白原(fibrinogen,Fib)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)分别为(19.3±5.3)%、(2.7±1.3)s、(1.1±0.5)g/L、(106.2±40.1)s,对照组为(46.8±12.0)%、(1.2±0.3)s、(1.4±0.6)g/L、(40.9±14.0)s,均优于治疗前,且观察组PTA、Fib低于对照组,INR、APTT长于对照组,差异有统计学意义(P<0.05)。观察组治疗后≤6 h的PTA为(37.0±12.5)%、APTT(76.8±10.5)s,高于治疗后>6 h的(34.0±10.2)%、(72.0±12.4)s,差异有统计学意义(P<0.05)。观察组治疗后≤6 h的R值为(9.3±3.3)min,α角为(38.8±8.2)°,MA为(30.6±13.2)mm,CI为(-8.7±1.8),优于治疗后>6 h的(11.4±7.1)min、(34.6±16.4)°、(26.5±12.7)mm、(-10.5±5.8),差异有统计学意义(P<0.05)。观察组治疗后的肝功能水平低于对照组,差异有统计学意义(P<0.05)。�Objective To analyze the in fluence of thromboelastography(TEG)and routine coagulation function test on plasma exchange therapy(PE)and continuous blood purification(CBP)treatment in patients with liver failure.Methods A total of 220 patients with liver failure who were treated in the 910th Hospital of the Joint Logistic Support Force of the People's Liberation Army of China from January 2022 to October 2023 were selected.According to the preoperative comprehensive evaluation results,90 patients treated with PE were included in the control group,and 130 patients treated with CBP were included in the observation group.During the treatment of patients,both groups underwent regular coagulation function tests as a basis for evaluating the effectiveness of the treatment plan.The observation group also underwent TGE evaluation.The application effects of the two detection methods were compared.Results After treatment,after TEG examination,reaction time(R),angle(α),maximum amplitude(MA)and coagulation index(CI)in observation group were(7.8±2.6)min,(44.1±10.4)°,(37.8±7.4)mm and(-6.7±1.5),which were better than before treatment(11.8±3.2)min,(37.2±9.5)°,(34.0±8.5)mm,(-10.6±1.6),and the difference was statistically significant(P<0.05).After treatment,the prothrombin time(PTA),international normalized ratio(INR),fibrinogen(Fib)and activated partial thromboplastin time(APTT)of the observation group were(19.3±5.3)%,(2.7±1.3)s,(1.1±0.5)g/L,(106.2±40.1)s after routine coagulation function examination.The control group was(46.8±12.0)%,(1.2±0.3)s,(1.4±0.6)g/L and(40.9±14.0)s,all of which were better than before treatment,PTA and Fib in observation group were lower than control group,INR and APTT were longer than control group,the difference was statistically significant(P<0.05).The PTA and APTT of observation group≤6 h after treatment were(37.0±12.5)%and(76.8±10.5)s,higher than(34.0±10.2)%and(72.0±12.4)s of>6 h after treatment,the difference was statistically significant(P<0.05).The R value of observation gr

关 键 词：肝衰竭 PE CBP TEG 常规凝血功能检查 肝功能 

分 类 号：R446[医药卫生—诊断学]