高岭土—血栓弹力图参考区间的建立及其指导心脏瓣膜置换术后输血的应用价值

发布时间：2018-02-24 09:11

本文关键词： 血栓弹力图参考区间凝血血栓弹力图心脏瓣膜假体植入输血　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的建立安徽汉族健康成年人群高岭土-血栓弹力图的参考区间。方法依据美国临床和实验室标准化协会(CLSI)C28-A3的文件规范,采用高岭土-血栓弹力图测定1681例安徽地区18~65岁的汉族健康成年人的凝血功能,对所取样本进行性别、年龄分组比较,以非参数百分位数法计算目标人群血栓弹力图的参考区间。结果安徽地区汉族健康成年人群的高岭土-血栓弹力图参考区间男性为:R:4.2 8.7min、K:1.2 3.2 min、Angle:47.0 72.3°、MA:49.1 70.5 mm;女性为:R:3.7 9.0 min、K:1.0 3.2 min、Angle:48.4 74.4°、MA:46.8 72.4 mm。而通过分组比较发现,在女性组和高龄组人群中所测得的血栓弹力图参数均提示其血液呈相对高凝状态。结论本研究依据规范建立了安徽汉族健康成年人群血栓弹力图的参考区间,可为临床和实验室的相关研究提供参考。目的探讨血栓弹力图在成人心脏瓣膜置换术后于ICU期间监测血凝及指导输血的应用价值。方法回顾分析经体外循环行心脏瓣膜置换手术的118例成人患者,依据指导患者术后在ICU期间输血的止凝血检测方法不同,分为血栓弹力图组(TEG组)62例与标准凝血试验组(SCT组)56例,对两组间人口统计学特征、术前止凝血功能、术中血液出入量的差异进行比较,同时统计分析两组患者于ICU期间的引流量与血制品输注情况及气管插管时间、住ICU时间等指标。结果两组患者人口统计学特征、心功能分级、术前止凝血功能无差别(P0.05),术中各类型血制品平均输注量无统计差异(P0.05)。与SCT组相比,TEG组患者术后于ICU期间血浆输注量显著减少(P0.01),血小板输注量虽未达统计学差异水平但有明显减少(P=0.086),两组红细胞输注量无差别(P0.05)。未发现两组患者间短期转归指标如引流量、气管插管时间、住ICU时间及ICU后出院时间等存在明显区别(P0.05)。结论可以运用TEG来监测成人患者心脏换瓣手术后的止凝血功能并且指导输血,它对患者术后转归无明显影响的同时可减少血浆与血小板的使用量,这对精准输血具有重要意义。
[Abstract]:Objective to establish the reference interval of kaolin thromboelastic map in healthy adult population of Anhui Han nationality. Methods according to the document specification of CLSIC28-A3, the American Association of Clinical and Laboratory Standardization, The clotting function of 1681 healthy Han nationality adults aged 18 to 65 years old in Anhui area was measured by kaolin thromboelastography. The sex and age groups of the samples were compared. Results the reference interval of kaoline-thromboelastic map for healthy adults of Han nationality in Anhui area was calculated by non-parametric percentile method. Results the reference interval of Kaolin and thromboelastic map for healthy adults in Anhui area was: 1: r: 4.2 + 8.7min K: 1.2 + 3.2 min Angle: 47.0 / 72.3 掳/ MA: 49.1 / 70.5 mm; female =: R3.7 = 9.0 min / K: 1.0. 3. 2 min Angle: 48.4 / 74.4 掳/ MAW 46.8 / 72.4 mm. and compared with each other, The parameters of thromboelastogram in both female and elderly population indicated that the blood was relatively hypercoagulable. Conclusion the reference interval of thromboelastogram in healthy adult population of Anhui Han nationality was established according to the criterion. Objective to explore the value of thromboelastography in monitoring hemagglutination and guiding blood transfusion during ICU after cardiac valve replacement in adults. 118 adult patients undergoing visceral valve replacement, According to the different methods of blood transfusion during ICU, the patients were divided into thromboelastogram group (62 cases) and standard coagulation test group (56 cases). The difference of blood volume during operation was compared, and the drainage volume, transfusion of blood products, time of endotracheal intubation and ICU duration during ICU were statistically analyzed in the two groups. Results the demographic characteristics and cardiac function grading of the two groups were analyzed. There was no significant difference in blood coagulation function before operation (P 0.05), and there was no statistical difference in the average volume of blood products during operation. Compared with SCT group, plasma infusion volume decreased significantly during ICU period, and platelet transfusion volume did not reach statistical difference. There was no significant difference in erythrocyte infusion volume between the two groups (P 0.05). There were significant differences in tracheal intubation time, ICU stay time and discharge time after ICU. Conclusion TEG can be used to monitor the anticoagulant function of adult patients after cardiac valve replacement and to guide blood transfusion. It can reduce the use of plasma and platelet, which is of great significance for accurate blood transfusion.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2;R446.11

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