肝素酶纠正血栓弹力图对围术期患者凝血功能的监测结果
|
摘要
目的探讨肝素酶纠正的血栓弹力图试验(hmTEG)对围术期患者凝血功能监测意义,并指导临床合理用血.方法收集围术期患者60例,比较hmTEG和TEG(未去除残留肝素)各参数之间的差异,同时比较hmTEG指导用血与TEG之间的差异.结果 hmTEG和TEG比较结果显示:R值(凝血时间)、MA值(描记图最大振幅强度)、CI值(凝血综合指数)之间存在明显差异,差异具有统计学意义(P<0.05),K值(血凝块形成时间)和Angle角(α角,血凝块形成点至描记图最大曲线弧度所作切线与水平线的夹角)之间差异无统计学意义(P>0.05).用血情况比较结果显示:血浆和血小板用量在hmTEG指导用血和临床TEG用血之间存在差异,差异具有统计学意义(P<0.05).结论 hmTEG方法可以更准确反映出围手术期患者凝血情况,同时指导临床合理输血.
Objective To explore the significance of thrombus and heparase comparison test(hmTEG) for monitoring coagulation function in perioperative patients and to guide the clinical use of blood.Method Collected 60 perioperative patients,compared hmTEG and ordinary TEG(not remove residual heparin)the difference between each parameter,at the same time compared the difference between hmTEG guide blood and clinical application of blood.Results The compared results between hmTEG and ordinary TEG showed that there are significant differences among R value(clotting time),MA value(trace the maximum amplitude of strength),CI(clotting index),the difference has statistically significant(P < 0. 05),the difference between K value(blood clot formation time) and Angle(alpha angle,a blood clot formed point to trace the biggest curve radian angle of tangent line and horizontal line) was not statistically significant(P>0.05).The results showed that there was difference between the blood plasma and platelet dosage of hmTEG in blood and clinical application,and the difference was statistically significant(P<0.05).Conclusion The hmTEG method can accurately reflect the coagulation of patients in perioperative period,and it is of certain significance to guide clinical blood transfusion.
Objective To explore the significance of thrombus and heparase comparison test(hmTEG) for monitoring coagulation function in perioperative patients and to guide the clinical use of blood.Method Collected 60 perioperative patients,compared hmTEG and ordinary TEG(not remove residual heparin)the difference between each parameter,at the same time compared the difference between hmTEG guide blood and clinical application of blood.Results The compared results between hmTEG and ordinary TEG showed that there are significant differences among R value(clotting time),MA value(trace the maximum amplitude of strength),CI(clotting index),the difference has statistically significant(P < 0. 05),the difference between K value(blood clot formation time) and Angle(alpha angle,a blood clot formed point to trace the biggest curve radian angle of tangent line and horizontal line) was not statistically significant(P>0.05).The results showed that there was difference between the blood plasma and platelet dosage of hmTEG in blood and clinical application,and the difference was statistically significant(P<0.05).Conclusion The hmTEG method can accurately reflect the coagulation of patients in perioperative period,and it is of certain significance to guide clinical blood transfusion.
引文
[1]燕姿辰,杨新春,张新,等.用血栓弹力图评价肝素浓度变化对凝血系统的影响[J].沈阳药科大学学报,2012,29(8):644-649.
[2] Coppell J A,Thalheimer U,Zambruni A,et al.The effects of unfractionated heparin,low molecular weight heparin and danaparoid on the thromboelastogram(TEG):an invitro comparison of standard and heparinase-modified TEGs with conventional coagulation assays[J]. Blood Coagul Fibrinolysis,2006,17(2):97-104.
[3] Weitzel N S,Weitzel L B,Epperson L E,et al. Platelet mapping as part of modified thromboelastography(TEG)in patients undergoing cardiacsurgery and cardiopulmonary bypass[J].Anaesthesia,2012,67(10):1158-1165.
[4] T ripodi A,Primignani M,Chantarangkul V,et al. The coagulopathy of cirrhosis assessed by thromboelastometry and its correlation with conventional coagulation parameters[J].Thromb Res,2009,124(1):132-136.
[5] Luddington R J.Thrombelastography/thromboelastometry[J].Clin Lab Haematol,2005,27(2):81-90.
[6] Hunt H,Stanworth S,Curry N,et al.Thromboelastography(TEG)and rotational thromboelastometry(ROTEM)for trauma induced coagulopathy in adult trauma patients with bleeding[J].Cochrane Database Syst Rev,2015,15(2):1-52.
[7]金悦,刘凤华.血栓弹力图肝素酶对比试验对心外科大血管手术患者合理用血的指导作用[J].检验医学与临床,2016,13(13):1866-1868.
[8] Hui P,Cook D J,Lim W,et al.The frequency and clinical significance of thrombocytopenia complicating critical illness:a systematic review[J]. Chest,2011,139(2):271-278.
[9] Cotton B A,Harvin J A,Kostousouv V,et al. Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration[J]. J Trauma Acute Care Surg,2012,73(2):365-370.
[2] Coppell J A,Thalheimer U,Zambruni A,et al.The effects of unfractionated heparin,low molecular weight heparin and danaparoid on the thromboelastogram(TEG):an invitro comparison of standard and heparinase-modified TEGs with conventional coagulation assays[J]. Blood Coagul Fibrinolysis,2006,17(2):97-104.
[3] Weitzel N S,Weitzel L B,Epperson L E,et al. Platelet mapping as part of modified thromboelastography(TEG)in patients undergoing cardiacsurgery and cardiopulmonary bypass[J].Anaesthesia,2012,67(10):1158-1165.
[4] T ripodi A,Primignani M,Chantarangkul V,et al. The coagulopathy of cirrhosis assessed by thromboelastometry and its correlation with conventional coagulation parameters[J].Thromb Res,2009,124(1):132-136.
[5] Luddington R J.Thrombelastography/thromboelastometry[J].Clin Lab Haematol,2005,27(2):81-90.
[6] Hunt H,Stanworth S,Curry N,et al.Thromboelastography(TEG)and rotational thromboelastometry(ROTEM)for trauma induced coagulopathy in adult trauma patients with bleeding[J].Cochrane Database Syst Rev,2015,15(2):1-52.
[7]金悦,刘凤华.血栓弹力图肝素酶对比试验对心外科大血管手术患者合理用血的指导作用[J].检验医学与临床,2016,13(13):1866-1868.
[8] Hui P,Cook D J,Lim W,et al.The frequency and clinical significance of thrombocytopenia complicating critical illness:a systematic review[J]. Chest,2011,139(2):271-278.
[9] Cotton B A,Harvin J A,Kostousouv V,et al. Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration[J]. J Trauma Acute Care Surg,2012,73(2):365-370.