血栓弹力图和常规凝血四项检测在评估肝癌患者围术期凝血功能中的应用研究
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摘要
目的:研究血栓弹力图(TEG)和常规凝血四项在评估肝癌患者围术期凝血功能中的应用。方法 :纳入进行肝癌手术的患者47例作为手术组,同时选取同时期入院进行体检的健康人40例作为对照组。比较术前手术组和对照组患者术前的凝血四项和TEG指标,包括纤维蛋白原(FIB)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、血凝时间(R值)、血块形成时间(K值)、血凝速率(α)和血块强度(MA)。比较围术期不同时间患者凝血四项的变化。比较围术期不同时间患者TEG指标的变化。结果:手术组的K值显著低于对照组(P<0.05),α和MA显著高于对照组(P<0.05),手术组和对照组R值相比,差异无统计学意义(P>0.05)。TEG图像显示,手术组47例肝癌患者中,85.11%(40/47)的肝癌患者为高凝状态,6.38%(3/47)的患者表现为低凝状态。凝血四项结果显示,手术组47例肝癌患者中,10.64%(5/47)的患者表现为高凝状态。与T_0相比,FIB、PT、TT在T_1～T_5时变化比较,差异无统计学意义(P>0.05)。与T_0相比,APTT在T_3～T_5时显著降低(P<0.05),在T_1、T_2的变化与T_0相比,差异无统计学意义(P>0.05)。与T_0相比,T_2和T_3的R值明显缩短(P<0.05),α在T_2、T_3时明显增宽(P<0.05),T_5时明显缩短(P<0.05),MA在T_1、T_2、T_3时明显增宽(P<0.05)。与T_0相比,K值在T_2～T_5时变化均不显著(P>0.05)。结论:肝癌患者的血液多数处于高凝状态,TEG和常规凝血四项均能对肝癌患者围术期血液的高凝状态进行分析,然而TEG的变化更为敏感。
Objective: To study the application of thromboelastography(TEG) and conventional coagulation in the evaluation of perioperative coagulation function in patients with liver cancer. Methods: 47 patients who underwent liver cancer surgery in our hospital from May 2017 to December 2018 were enrolled as the operation group. 40 healthy people who were admitted to the hospital for physical examination at the same time were selected as the control group. The preoperative coagulation quadruple and TEG indicators were compared between the preoperative surgery group and the control group,including FIB,PT,TT,APTT,R value,K value,α and MA. Compare the changes in coagulation in patients with different times during the perioperative period. The changes in TEG index were compared between patients at different times during the perioperative period. Results:The K value of the operation group was significantly lower than that of the control group(P<0.05),and α and MA were significantly higher than the control group(P<0.05). There was no significant difference between the operation group and the control group in R value(P>0.05). TEG images showed that 85.11%(40/47) of the liver cancer patients in the surgical group were hypercoagulable,and 6.38%(3/47) patients showed hypocoagulability. Four results of coagulation showed that 10.64%(5/47) of the 47 patients with liver cancer in the surgical group showed hypercoagulability. Compared with T_0,the changes of FIB,PT and TT were not significant at T_1～T_5(P>0.05). Compared with T_0,APTT was significantly decreased at T_3～T_5(P<0.05),there was no significant difference in T_1 and T_2 changes compared withT_(0 )(P>0.05). Compared with T_0,T_2 and T_3 R values were significantly shortened(P<0.05),α was significantly broadened at T_2 and T_3(P<0.05),and significantly shortened at T_5(P<0.05). MA was significantly broadened at T_1,T_2,and T_3(P<0.05). Compared with T_0,the K value did not change significantly at T_2～T_5(P>0.05). Conclusion: The blood of patients with liver cancer is mostly hypercoagulable. Both TEG and conventional coagulation can analyze the hypercoagulable state of perioperative blood in patients with liver cancer. However,the change of TEG is more sensitive.
Objective: To study the application of thromboelastography(TEG) and conventional coagulation in the evaluation of perioperative coagulation function in patients with liver cancer. Methods: 47 patients who underwent liver cancer surgery in our hospital from May 2017 to December 2018 were enrolled as the operation group. 40 healthy people who were admitted to the hospital for physical examination at the same time were selected as the control group. The preoperative coagulation quadruple and TEG indicators were compared between the preoperative surgery group and the control group,including FIB,PT,TT,APTT,R value,K value,α and MA. Compare the changes in coagulation in patients with different times during the perioperative period. The changes in TEG index were compared between patients at different times during the perioperative period. Results:The K value of the operation group was significantly lower than that of the control group(P<0.05),and α and MA were significantly higher than the control group(P<0.05). There was no significant difference between the operation group and the control group in R value(P>0.05). TEG images showed that 85.11%(40/47) of the liver cancer patients in the surgical group were hypercoagulable,and 6.38%(3/47) patients showed hypocoagulability. Four results of coagulation showed that 10.64%(5/47) of the 47 patients with liver cancer in the surgical group showed hypercoagulability. Compared with T_0,the changes of FIB,PT and TT were not significant at T_1～T_5(P>0.05). Compared with T_0,APTT was significantly decreased at T_3～T_5(P<0.05),there was no significant difference in T_1 and T_2 changes compared withT_(0 )(P>0.05). Compared with T_0,T_2 and T_3 R values were significantly shortened(P<0.05),α was significantly broadened at T_2 and T_3(P<0.05),and significantly shortened at T_5(P<0.05). MA was significantly broadened at T_1,T_2,and T_3(P<0.05). Compared with T_0,the K value did not change significantly at T_2～T_5(P>0.05). Conclusion: The blood of patients with liver cancer is mostly hypercoagulable. Both TEG and conventional coagulation can analyze the hypercoagulable state of perioperative blood in patients with liver cancer. However,the change of TEG is more sensitive.
引文
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[2] 闫震,叶峰山,张军,等.肝病患者凝血四项的检测分析[J].中国药物与临床,2016,16(4):576-577.
[3] 王玉连,陈洪,刘洋,等.血栓弹力图在评估肝硬化患者凝血状态中的作用[J].东南大学学报:医学版,2016,35(2):215-219.
[4] 刘会春.中国原发性肝癌治疗指南解读[J].肝胆外科杂志,2013,21(1):12-14.
[5] 成厚丕,兰军.原发性肝癌介入治疗前后患者凝血、纤溶功能和血小板变化的临床意义[J].血栓与止血学,2017,23(4):656-658.
[6] 黄洁,张凡雄,刘庆,等.原发性肝癌中医分型与凝血功能相关性分析[J].国际检验医学杂志,2017,38(11):1493-1494.
[7] 王国有,梁小利,拓红晓,等.凝血功能及血小板相关参数检测对肝病诊治的临床价值[J].中国医学工程,2016,24(6):40-42.
[8] 李正康,张鑫强,刘素玲,等.凝血四项指标和肿瘤标志物在乙型肝炎病毒感染相关肝硬化和原发性肝癌中的诊断价值[J].中国实验诊断学,2016,20(12):2061-2065.
[9] 陈勇,凌建,徐容,等.影响凝血四项检测结果异常原因的分析[J].中国实验诊断学,2017,21(9):1523-1527.
[10] 曾小飞,尚观胜,马瑞东.血栓弹力图在胸外科围手术期的应用进展[J].山东医药,2018,58(9):106-109.
[11] 吕自兰,王宾琳,张阳,等.血栓弹力图与凝血功能检测、血小板计数在恶性肿瘤患者中的相关性分析[J].国际检验医学杂志,2018,39(4):443-449.
[12] 董晓锋,周健,兰帅奇,等.血栓弹力图在评估肝癌患者高凝状态中的作用[J].中国输血杂志,2014,27(9):931-933.
[13] 卢静,庄贵华.血栓弹力图监测老年无症状性脑梗死患者凝血功能的意义[J].陕西医学杂志,2016,45(10):1351-1352.
[14] 唐晓春.肝癌患者血栓弹力图与常规凝血四项相关性及其在指导临床输血中的应用[J].国际医药卫生导报,2018,24(5):743.