血栓弹力图在体外循环心脏直视手术围术期凝血功能变化的初步研究

发布时间：2019-06-24 11:44

【摘要】：目的通过血栓弹力图(TEG)的分析,对体外循环心脏直视手术患者围术期凝血功能的变化进行初步研究。通过TEG的监测,比较瓣膜置换手术、先天性心脏病矫治手术及主动脉大血管手术三种手术类型对患者凝血功能影响有无不同,评估TEG在体外循环手术中的监测意义。方法选择2015年11月至2017年3月在煤炭总医院心脏中心明确诊断需行择期体外循环心脏直视手术的患者34例。按术式分为瓣膜置换手术组(A组),先天性心脏病矫治手术组(B组),大血管手术组(C组)。所有患者均在全身静脉吸入复合麻醉、体外循环心脏直视下进行手术。选用西芬斯LEPU-8800血栓弹力图仪进行TEG检测,对所获得病例的数据进行及时整理、记录并分类统计。结果1.各组例数及所占比分别为17例(50.00%)、15例(44.12%)、2例(5.88%)。比较三组患者的临床基本资料,差异无统计学意义(P0.05);2.体外循环心脏直视手术前后患者血红蛋白及血小板存在显著差异(P=0.000);体外循环心脏直视手术后血栓弹力图普通杯中R值与K值较术前值升高,α-Angle角、MA值及CI值较之术前值则有所降低;术后血栓弹力图肝素酶杯中R值、K值和MA值较术后普通杯值下降,α-Angle角和CI值则较之普通杯值有所升高;术后血栓弹力图肝素酶杯中R值、K值较术前普通杯值上升,α-Angle角、MA值和CI值则较之普通杯值有所下降;3.体外循环心脏直视手术不同术式之间术前普通杯R值、K值、α-Angle角、MA值及CI值无统计学差异(P0.05);不同术式之间术后普通杯与术后肝素酶杯的R值、K值、α-Angle角、MA值及CI值存在统计学差异(P0.05)。结论1.体外循环后,患者TEG提示患者凝血功能减弱。2瓣膜置换手术、先天性心脏病矫治手术及大血管手术三种术式手术前后TEG改变不同。3.TEG可以评估患者凝血功能,是一种便捷有效的方法。
[Abstract]:Objective To study the changes of blood coagulation function in patients undergoing open heart surgery with cardiopulmonary bypass (TEG). The effects of three types of operation types on the coagulation function of the patients were compared with the three types of operation types, such as valve replacement, congenital heart disease, and aortic large-vessel operation, and the monitoring significance of TEG in the operation of cardiopulmonary bypass was evaluated. Methods Thirty-four patients with open heart surgery were selected from November 2015 to March 2017 at the heart center of the General Hospital of the Coal General Hospital. The operation procedure was divided into three groups: group A, group B, and group C. All patients were given a combination of anesthesia with the whole body, and the operation was performed under the open heart. The data of the obtained cases were sorted, recorded and classified according to the TEG test by using the Sphens LEPU-8800 thromboelastograph. Results 1. The number and proportion of each group were 17 (50.00%),15 (44.12%) and 2 (5.88%), respectively. There was no significant difference in the clinical basic data of the three groups (P0.05). There was a significant difference in hemoglobin and platelet in the patients before and after the open heart surgery (P = 0.000), and the value of R and K in the normal cup was higher than the pre-operative value of the normal cup after the open heart operation. The value of R-value, K-value and MA-value of the post-operative thromboelastogram were lower than that of the common cup after operation. The value of R-Angle and CI was higher than that of the common cup. The value of R-value and K-value in the heparin-enzyme cup after operation was higher than that of the normal cup before operation. The MA value and the CI value decrease compared to the normal cup value;3. There was no statistical difference between the value of the common cup (R), the K value, the angle of the knee-Angle, the MA value and the value of the CI (P0.05). The R value, the K value, the angle of the K-Angle of the common cup and the post-operative heparin-enzyme cup between different operation methods were not statistically different (P0.05). There was a statistical difference between the values of MA and CI (P0.05). Conclusion 1. After the cardiopulmonary bypass, the patient's TEG suggested that the coagulation function of the patient was weakened. The changes of the TEG before and after the operation of valve replacement, the treatment of congenital heart disease and the operation of the large blood vessel were different.3. The TEG can evaluate the coagulation function of the patient, and it is a convenient and effective method.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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