血栓弹力图在评价重症多瓣膜病患者围术期凝血功能中的应用
发布时间：2018-11-06 18:53
【摘要】：目的:探讨血栓弹图(TEG)在重症多瓣膜病患者术后凝血功能评估及指导成分输血、术后抗凝中的意义。方法:回顾性分析近5年成功进行手术治疗的62例重症多瓣膜病患者,对比术前和术后1h和48h各项TEG检测参数及传统血常规和凝血机制检测参数,并将术后1h各项参数与术后输注血浆、血小板和冷沉淀量进行相关性分析。结果:术后1h的R值和K值明显延长(P0.05),术后1h的α-Angle值和MA值明显减小(均P0.05),血常规显示术后1h血小板(PLT)计数明显降低(P0.05),传统的凝血项检测纤维蛋白原(FIB)术后1h明显降低(P0.05),部分活化凝血酶原时间(APTT)、凝血酶原时间(PT)和INR值术后1h均明显延长(均P0.05)。Ly30(%)在手术后1h升高(P0.05),术后48h较术后无显著差异。术后血浆输注量与R值有显著相关性(P0.05),血小板输注量与MA和PLT计数有显著相关性(均P0.05),冷沉淀输注量与K值、α-Angle和APTT有显著相关性(均P0.05)。结论:TEG可提示重症多瓣膜病手术患者术后的凝血功能障碍,R值可以指导血浆的输注,MA值可以指导血小板的输注,K值、α-Angle可以作为术后冷沉淀输注的重要参考,Ly30(%)在手术后1h升高提示继发性纤溶功能亢进,术后48h较术后无显著差异,提示患者凝血功能恢复,应给予华法林等抗凝药物,预防血栓形成。
[Abstract]:Objective: to investigate the significance of thromboelastography (TEG) in evaluating postoperative coagulation function and guiding blood component transfusion and anticoagulant after operation in patients with severe multi-valvular disease. Methods: 62 patients with severe polyvalvular disease who were successfully operated in recent 5 years were analyzed retrospectively. The parameters of TEG, traditional blood routine and coagulation mechanism were compared before and 1 and 48 hours after operation. The correlation of the parameters with plasma, platelet and cryoprecipitation was analyzed. Results: the values of R and K were significantly prolonged at 1 hour after operation (P0.05), 伪-Angle and MA were significantly decreased at 1 hour after operation (P0.05), and the platelet (PLT) count was significantly decreased at 1 hour after operation (P0.05). The traditional thromboplastin test for fibrinogen (FIB) decreased significantly 1 hour after operation (P0.05), and partially activated prothrombin time (APTT),). Prothrombin time (PT) and prothrombin INR (INR) were significantly prolonged 1 hour after operation (P0.05). Ly30 (%) increased 1 hour after operation (P0.05), but there was no significant difference between 48 hours after operation and 48 hours after operation. There was a significant correlation between plasma infusion volume and R value (P0.05), platelet infusion volume with MA and PLT count (P0.05), cryoprecipitation infusion volume and K value, 伪 -Angle and APTT (P0.05). Conclusion: TEG can indicate the postoperative coagulation dysfunction in patients with severe multi-valvular disease, R value can guide plasma infusion, MA value can guide platelet infusion, K value and 伪-Angle can be used as an important reference for cryoprecipitation infusion after operation. The increase of Ly30 (%) at 1h after operation suggested secondary hyperfibrinolysis, but there was no significant difference at 48h after operation. It suggested that the coagulation function of the patients recovered, so warfarin and other anticoagulants should be given to prevent thrombosis.
【作者单位】： 云南省第二人民医院;
【基金】：云南省科技厅-昆明医科大学应用基础研究联合专项(No:2014FZ045)
【分类号】：R654.2
本文编号：2315164
[Abstract]:Objective: to investigate the significance of thromboelastography (TEG) in evaluating postoperative coagulation function and guiding blood component transfusion and anticoagulant after operation in patients with severe multi-valvular disease. Methods: 62 patients with severe polyvalvular disease who were successfully operated in recent 5 years were analyzed retrospectively. The parameters of TEG, traditional blood routine and coagulation mechanism were compared before and 1 and 48 hours after operation. The correlation of the parameters with plasma, platelet and cryoprecipitation was analyzed. Results: the values of R and K were significantly prolonged at 1 hour after operation (P0.05), 伪-Angle and MA were significantly decreased at 1 hour after operation (P0.05), and the platelet (PLT) count was significantly decreased at 1 hour after operation (P0.05). The traditional thromboplastin test for fibrinogen (FIB) decreased significantly 1 hour after operation (P0.05), and partially activated prothrombin time (APTT),). Prothrombin time (PT) and prothrombin INR (INR) were significantly prolonged 1 hour after operation (P0.05). Ly30 (%) increased 1 hour after operation (P0.05), but there was no significant difference between 48 hours after operation and 48 hours after operation. There was a significant correlation between plasma infusion volume and R value (P0.05), platelet infusion volume with MA and PLT count (P0.05), cryoprecipitation infusion volume and K value, 伪 -Angle and APTT (P0.05). Conclusion: TEG can indicate the postoperative coagulation dysfunction in patients with severe multi-valvular disease, R value can guide plasma infusion, MA value can guide platelet infusion, K value and 伪-Angle can be used as an important reference for cryoprecipitation infusion after operation. The increase of Ly30 (%) at 1h after operation suggested secondary hyperfibrinolysis, but there was no significant difference at 48h after operation. It suggested that the coagulation function of the patients recovered, so warfarin and other anticoagulants should be given to prevent thrombosis.
【作者单位】： 云南省第二人民医院;
【基金】：云南省科技厅-昆明医科大学应用基础研究联合专项(No:2014FZ045)
【分类号】：R654.2
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