血栓弹力图与凝血试验对指导心脏手术患者围术期输血中的意义

发布时间：2017-12-28 10:56

本文关键词：血栓弹力图与凝血试验对指导心脏手术患者围术期输血中的意义　出处：《中国输血杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的探讨血栓弹力图(thromboelastography,TEG)与凝血试验各项指标的相关性,评价两种方法在指导心脏手术患者围术期输血中的意义。方法分析本院2014年9月—2016年8月收治的108位心脏手术患者,随机分为TEG检测指导输血组(实验组)和凝血试验指导输血组(对照组),分别就两组的输血率、不同成分血的输血量及输血效果进行比较。结果对TEG和凝血试验指导心脏手术围术期用血率的比较,发现试验组指导冷沉淀25.9%和新鲜冰冻血浆33.3%的输注率明显低于对照组的68.5%,而血小板的输注率57.4%却明显高于对照组的20.4%;两组红细胞的输注率差异无统计学意义,但红细胞的输注量试验组(3.6+1.6)明显低于对照组(5.8+1.9),试验组指导的新鲜冰冻血浆和冷沉淀的输注量也明显低于对照组(P0.05);两组术中出血量、术后出血量、再次出血率方面,试验组均低于对照组(P0.05)。结论血栓弹力图指导心脏手术患者围术期输血可减少血液制剂的使用量,并对疾病的预后转归优于常规凝血试验指导的用血,减少手术并发症及出血量,对指导临床成分输血具有重要意义,值得推广。
[Abstract]:Objective to investigate the correlation between thromboelastography (TEG) and various indexes of coagulation test, and to evaluate the significance of two methods in guiding perioperative blood transfusion in patients undergoing cardiac surgery. Methods 108 patients undergoing cardiac surgery in our hospital from September 2014 to August 2016 were selected, randomly divided into TEG detection guide blood transfusion group (experimental group) and blood coagulation test guide blood transfusion group (control group), blood transfusion volume and the effect of each of the two groups of different component blood transfusion rates, in comparison. The results of comparison with the rate of TEG and blood coagulation test for cardiac surgery, found that the test group guidance 25.9% cryoprecipitate and fresh frozen plasma 33.3% infusion rate was significantly lower than the control group 68.5%, and the platelet infusion rate 57.4% was significantly higher than the control group 20.4%; injection rate between the two groups of red blood cell transfusion there was no statistical significance, but the red blood cell transfusion test group (3.6+1.6) was significantly lower than the control group (5.8+1.9), the test group guidance of fresh frozen plasma and cryoprecipitate infusion volume was significantly lower than the control group (P0.05); the two group of intraoperative bleeding, postoperative bleeding, rebleeding rate and the test group were lower than the control group (P0.05). Conclusion Thromboelastograms guidance in patients undergoing cardiac surgery perioperative blood transfusion can reduce the amount of blood preparation, and prognosis of the disease outcome is better than the conventional coagulation test guided by blood, reduce complications and blood loss, is of great significance to guide the clinical transfusion of blood components, worthy of promotion.
【作者单位】：复旦大学附属华山医院输血科;
【基金】：国家自然科学基金面上项目(81470351) 上海市公共卫生重点学科建设项目(15GWZK0501)
【分类号】：R457.1;R654.2
【正文快照】： 随着我国心血管疾病的发病率越来越高,胸外科心脏手术量有逐年增高的趋势。由于心脏手术时往往需要施行体外循环易导致患者凝血功能紊乱,从而引起术中或术后伤口严重渗血。有资料表明,患者术后出血及一些不合理输血会导致术后并发症及死亡率的增加[1]。因此,及时准确地诊治心

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