血栓弹力图与凝血四项精准指导肝硬化患者输血治疗的价值差异  

Precise blood transfusion thromboelastography versus four coagulation parameters for patients with liver cirrhosis

作　　者：杜旭利 白艳丽 樊艳婷 侯爱丽 Du Xuli;Bai Yanli;Fan Yanting;Hou Aili(Blood Transfusion Department,Xi'an International Medical Center Hospital,Xi'an 710010,China;Blood Transfusion Department,Xi'an International Medical Center Hospital,Northwest University,Xi'an 710010,China;Laboratory Department,Huazhou District People's Hospital,Weinan 714100,China)

机构地区：[1]西安国际医学中心医院输血科,西安710010 [2]西北大学附属西安国际医学中心医院输血科,西安710010 [3]渭南市华州区人民医院检验科,渭南714100

出　　处：《国际医药卫生导报》2025年第6期940-944,共5页International Medicine and Health Guidance News

基　　金：国家自然科学基金(82202550)。

摘　　要：目的比较血栓弹力图(TEG)和凝血四项精准指导肝硬化患者输血治疗的价值差异。方法采用前瞻性研究,选取2022年4月至2024年3月在西安国际医学中心医院行输血治疗的157例肝硬化患者作为研究对象,通过随机数字表法分为对照组(78例)和观察组(79例)。对照组男42例、女36例,年龄(54.83±9.35)岁,依据凝血四项结果指导输血治疗;观察组男44例、女35例,年龄(56.25±10.48)岁,依据TEG指标指导输血治疗。采用Pearson相关性分析患者输血前TEG指标[凝血反应时间(R)、Angle角、最大血凝块强度(MA)]和凝血四项[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)]的相关性。对比两组患者血液成分输注量、治疗前后凝血指标、输血不良反应发生情况、住院时间和住院费用。统计学方法采用t检验、χ^(2)检验。结果Pearson相关性分析结果显示,R与APTT(r=0.473,P<0.001)呈正相关;Angle角与PT(r=-0.367,P<0.001)、APTT(r=-0.392,P<0.001)呈负相关,与FIB(r=0.571,P<0.001)呈正相关;MA与FIB(r=0.594,P<0.001)呈正相关。观察组新鲜冰冻血浆、冷沉淀、红细胞悬液、单采血小板输注量分别为(203.75±37.58)ml、(13.26±4.04)U、(3.43±1.29)U、(1.48±0.28)U,均少于对照组[(287.37±46.72)ml、(17.54±3.76)U、(4.87±1.54)U、(2.05±0.26)U],差异均有统计学意义(t=8.580、4.638、5.133、9.921,均P<0.05)。治疗后24 h,观察组PT、APTT、TT均短于对照组[(14.01±4.33)s比(17.26±3.26)s、(34.28±4.74)s比(39.32±4.18)s、(19.87±3.52)s比(23.71±3.74)s],FIB指标高于对照组[(1.81±0.24)g/L比(1.53±0.17)g/L],差异均有统计学意义(t=5.308、7.063、6.626、8.426,均P<0.05)。观察组输血不良反应发生率为1.27%(1/79),低于对照组的10.26%(8/78),差异有统计学意义(χ^(2)=4.325,P=0.038)。观察组住院时间短于对照组[(9.08±2.87)d比(11.23±3.27)d],住院费用低于对照组[(5.17±1.05)万元比(5.83±1.21)万元],差异均Objective To explore the values of thromboelastography(TEG)versus four coagulation parameters in accurately guiding blood transfusion for patients with liver cirrhosis.Methods This was a prospective study.One hundred and fifty-seven patients with liver cirrhosis who underwent blood transfusion at Xi'an International Medical Center Hospital from April 2022 to March 2024 were divided into a control group(78 cases)and an observation group(79 cases)by the random number table method.The control group had 42 males and 36 females who were(54.83±9.35)years old.The observation group had 44 males and 35 females who were(56.25±10.48)years old.The control group received blood transfusion guided by the results of four coagulation parameters,and the observation groups received blood transfusion guided by TEG indicators.The Pearson correlation analysis was used to evaluate the correlation between TEG indicators[reaction time(R),Angle angle,and maximum amplitude(MA)]and the four coagulation parameters[activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),and fibrinogen(FIB)]before blood transfusion.The amounts of blood component transfusion,coagulation parameters before and after the treatment,occurrence of transfusion-related adverse reactions,hospital stays,and hospitalization costs were compared between the two groups.t andχ^(2) tests were used for the statistical analysis.Results The results of Pearson correlation analysis showed that R was positively correlated with APTT(r=0.473;P<0.001);Angle angle was negatively correlated with PT(r=-0.367;P<0.001)and APTT(r=-0.392;P<0.001),and positively correlated with FIB(r=0.571;P<0.001);MA was positively correlated with FIB(r=0.594;P<0.001).The infusion volumes of fresh frozen plasma,cold precipitate,red blood cell suspension,and platelet suspension in the observation group were(203.75±37.58)ml,(13.26±4.04)U,(3.43±1.29)U,and(1.48±0.28)U,respectively,which significantly lower than those in the control group[(287.37±46.72)ml,(17.54±3.76)U,(4.87±1.

关 键 词：肝硬化 输血治疗 血栓弹力图 凝血四项 

分 类 号：R457.1[医药卫生—治疗学] R575.2[医药卫生—临床医学]