血栓弹力图监测在行非体外循环冠状动脉旁路移植术患者围术期输血中的应用  

Application of Thromboelastograph Monitoring in Perioperative Blood Transfusion in Patients Undergoing OPCABG

作　　者：李桦 薛永平 孙萍萍 潘复亮 樊瑞军[1] LI Hua;XUE Yongping;SUN Pingping;PAN Fuliang;FAN Ruijun(Department of Clinical Laboratory,People’s Hospital of Ningxia Hui Autonomous Region,Third Clinical Medical College of Ningxia Medical University,Yinchuan 750002,China)

机构地区：[1]宁夏回族自治区人民医院临床医学检验诊断中心,宁夏医科大学第三临床医学院,银川750002

出　　处：《宁夏医科大学学报》2024年第8期782-785,790,共5页Journal of Ningxia Medical University

基　　金：宁夏科技惠民项目(2018KLHM0150)。

摘　　要：目的 探讨血栓弹力图(TEG)监测在行非体外循环冠状动脉旁路移植术(OPCABG)患者围术期输血中的应用效果。方法 选取122例行OPCABG需在围术期进行输血操作的患者,依据随机数字表法分为对照组和观察组,每组61例。对照组实施常规凝血监测,观察组采用TEG监测。对比两组围手术期患者血液制品的使用状况,凝血状态,输液量、出血量及输血量,相关药物使用情况及临床结局。结果 观察组悬浮红细胞(RSC)、新鲜冰冻血浆(FFP)、机采血小板、冷沉淀凝血因子水平均低于对照组(P均<0.05);与同组术前比,术后1 h两组患者血清血小板计数(PLT)、红细胞压积(HCT)、纤维蛋白原(FIB)、血红蛋白水平均降低,活化部分凝血活酶时间(APTT)均延长;观察组PLT、FFP输入量均少于对照组(P均<0.05)。但术前、术后1 h观察组与对照组相比,组间出血量、输液量、自体血输入量、RBC输入量、氨甲环酸、鱼精蛋白、FIB使用量、重症加强护理病房(ICU)停留时间、气管插管时间、住院时间、术后1 d内再次手术率、病死率比较,差异均无统计学意义(P均>0.05)。结论 TEG可有效监测OPCABG患者血液制品的使用状况,减少患者的输血量,且对患者的出血量及预后没有较大影响。Objective To investigate the application of TEG monitoring in perioperative blood transfusion in patients undergoing OPCABG.Methods A total of 122 patients who were admitted to our hospital from April 2019 to April 2022 for OPCABG surgery requiring blood transfusion during the perioperative period were selected and divided into the control group and the observation group according to the random number table method,with 61 cases in each group.The control group underwent routine blood coagulation monitoring,and the observation group underwent TEG monitoring.The use of blood products,coagulation status,perioperative infusion volume,blood loss and blood transfusion volume,perioperative drug use and clinical outcomes were compared between the two groups.Results The levels of suspended red blood cells(RBC),fresh frozen plasma(FFP),mechanically collected platelets and cryoprecipitate coagulation factors in the observation group were lower than those in the control group(P all<0.05).Compared with the same group before operation,the levels of serum platelet count(PLT),hematocrit,fibrinogen(FIB)and hemoglobin in the two groups decreased 1 h after operation,while activated partial thromboplastin time(APTT)was prolonged.The input of PLT and FFP in the observation group was less than that in the control group(P all<0.05).However,compared with the control group before operation and 1 h after operation,there was no significant difference in blood loss,transfusion,autologous blood input,RBC input,tranexamic acid,protamine,FIB usage,intensive care unit(ICU)stay time,tracheal intubation time,hospitalization time,reoperation rate and mortality rate between the control group and the observation group(P all>0.05).Conclusion TEG monitoring can effectively control the use of blood products in patients with OPCABG,reduce the blood transfusion volume of patients,and has no significant impact on the bleeding volume and prognosis of patients.

关 键 词：非体外循环冠状动脉旁路移植术 输血 围术期 血栓弹力图 

分 类 号：R619[医药卫生—外科学]