手术患者血容量、酸碱度及肝功能对TEG所示凝血功能的影响

发布时间：2018-06-16 11:48

本文选题：血栓弹力图 + 酸碱度　；参考：《昆明医科大学》2015年硕士论文

【摘要】：目的：本研究的目的在于通过检测择期手术患者的血栓弹力图(thrombelastography, TEG)指标,对其与患者术中氢离子活度指数(Pouvoir Hydrogene,PH)、碱剩余(buffuer excess,BE)、血红蛋白(hemoglobin, HB)、红细胞比容(hematocrit, HCT)、丙氨酸氨基转移酶(Alanine transaminase, ALT)、天门冬氨酸氨基转移酶(aspartate amino transferase, AST)之间存在的关系加以研究,以期为血容量、酸碱度、肝功能的差异能否预测出患者凝血功能,从而使用TEG进行手术患者凝血功能监测及指导合理用血提供依据。方法：选取昆明医科大学第一附属医院符合纳入排除标准的手术患者,记录一般情况及术前肝功能指标、术中TEG和动脉血气分析检测结果。数据收集完成后对患者PH、HB、HCT、BE、ALT、AST与TEG各指标的相关性进行统计学处理,再做进一步的回归分析。结果：本研究根据入选标准共纳入102名患者。患者HB、HCT分别与K值呈负相关,与Ma值和CI值呈正相关；AST值分别与K值呈正相关,与Ma值和CI值呈负相关。HB、HCT、AST对K值、Ma值和CI值的影响均有差异(P0.05),其中对K值影响最大的为AST,对Ma影响最大的为HB、HCT,对CI值影响最大的为HB、HCT。患者PH、BE、HB、HCT、ALT、AST对R值及a角的影响无差异,PH、BE、ALT对K值、Ma值和CI值的影响无差异。结论：1、HB、HCT降低和(或)AST升高的手术患者呈现相对低凝状态,其对凝血功能的影响可以在TEG指标中得以体现。对这部分患者可适当使用TEG进行凝血功能监测,防止可能的凝血功能异常为手术带来风险。2、围手术期时,应尽可能纠正和改善患者肝功能及血容量状况,有利于围手术期的凝血功能良好,以保证患者围手术期的生命安全。3、TEG在凝血功能监测方面更灵敏,发现异常情况更早期、更准确,且对凝血异常原因更有针对性,能够明确反映出是凝血系统还是纤溶系统异常,更具体表明异常原因为凝血因子、纤维蛋白原还是血小板异常。为临床治疗提供更可靠的依据,为抢救争取时间。
[Abstract]:Objective: the aim of this study was to detect thromboelastography (TEG) indexes in patients undergoing elective surgery. The relationship between the activity index of hydrogen ion during operation and the indexes of hydrogen ion activity during operation, such as hydrogen ion activity index, buffuer excess amino, hemoglobin, HBT, hematocrit, HCT, Alanine transaminase, alt, aspartate amino transferase (AST), was studied. It is expected that the difference of blood volume, pH and liver function can predict the coagulation function of the patients, and then use TEG to monitor the coagulation function of the patients and to guide the rational use of blood. Methods: the patients who met the exclusion criteria in the first affiliated Hospital of Kunming Medical University were selected, the general situation and preoperative liver function indexes were recorded, and the results of intraoperative TEG and arterial blood gas analysis were measured. After the data collection was completed, the correlation between HCT and TEG was statistically analyzed, and further regression analysis was made. Results: 102 patients were included in this study according to the inclusion criteria. HCT was negatively correlated with K value, positively correlated with Ma value and CI value, and positively correlated with K value. There is a negative correlation with Ma value and CI value. There are significant differences in the effect of HCT AST on K value and CI value (P 0.05), among which AST has the greatest influence on K value, HBH HCT has the greatest influence on Ma, and HBN HCT has the greatest influence on CI value. There was no difference in the effect of HCT and alt on R value and a angle in patients with PHB, and there was no difference in the effect of PHBEB alt on K value, Ma value and CI value. Conclusion the patients with decreased HCT and / or elevated AST in 1 / 1 HBT group showed a relatively low coagulation state, and the effect of HCT on coagulation function could be reflected in the TEG index. In order to prevent the possible abnormal coagulation function from bringing risks to the operation, we should correct and improve the patients' liver function and blood volume as much as possible during the perioperative period. It is beneficial to the coagulation function in perioperative period, so as to ensure the safety of patients' life during the perioperative period. 3TEG is more sensitive in monitoring coagulation function, and the abnormal condition is found earlier and more accurately, and the cause of abnormal coagulation is more targeted. It can clearly reflect the abnormality of coagulation system or fibrinolytic system, and more specifically indicate that the abnormal cause is coagulation factor, fibrinogen or platelet abnormality. To provide a more reliable basis for clinical treatment and to buy time for rescue.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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