血栓弹力图与传统凝血功能检测在不同患者围术期应用进展
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摘要
血栓弹力图(thrombelastography,TEG)现作为一种即时检验(point-of-care testing,POCT)设备正被广泛应用于临床各个领域,这项粘弹性止血试验(viscoelastic haemostatic assay,VHA)在临床医生诊断、决策以及治疗中也发挥着愈来愈重要的作用。传统凝血功能检测(conventional coagulation tests,CCTs)指标主要包括凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、国际标准化比值、纤维蛋白原、血浆D-二聚体以及血小板计数,这些常规检验项目在临床上同样不可缺少。TEG与CCTs在不同类型临床患者围术期凝血功能监测中往往各有优势与不足,评价角度亦有差异。
Thromboelastography(TEG)as a point-of-care testing(POCT)device is widely used in various clinical fields. This viscoelastic haemostatic assay(VHA)is also playing an increasingly important role in the diagnosis, decision-making and treatment of clinicians. Conventional coagulation tests(CCTs)mainly include prothrombin time(PT), activated partial thromboplastin time(APTT),thrombin time(TT), international normalized ratio(INR), fibrinogen(Fbg), plasma D-dimer and platelet count(PLT). These routine tests are also indispensable in clinical practice. TEG and CCTs have their own advantages and disadvantages in perioperative coagulation function monitoring of different types of clinical patients, and their evaluation perspectives are also different.
Thromboelastography(TEG)as a point-of-care testing(POCT)device is widely used in various clinical fields. This viscoelastic haemostatic assay(VHA)is also playing an increasingly important role in the diagnosis, decision-making and treatment of clinicians. Conventional coagulation tests(CCTs)mainly include prothrombin time(PT), activated partial thromboplastin time(APTT),thrombin time(TT), international normalized ratio(INR), fibrinogen(Fbg), plasma D-dimer and platelet count(PLT). These routine tests are also indispensable in clinical practice. TEG and CCTs have their own advantages and disadvantages in perioperative coagulation function monitoring of different types of clinical patients, and their evaluation perspectives are also different.
引文
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[25]Lodewyks C,Heinrichs J,Grocott H P,et al.Point-of-care viscoelastic hemostatic testing in cardiac surgery patients:a systematic review and meta-analysis[J].Can J Anaesth,2018,65(12):1333-1347.
[26]Abeysundara L,Mallett SV,Clevenger B.Point-of-care testing in liver disease and liver surgery[J].Semin Thromb Hemost,2017,43(4):407-415.
[27]De Pietri L,Bianchini M,Montalti R,et al.Thrombelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy:a randomized,controlled trial[J].Hepatology,2016,63(2):566-573.
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[29]McCrossin KE,Bramley DE,Hessian E,et al.Viscoelastic testing for hepatic surgery:a systematic review with meta-analysis-a protocol[J].Syst Rev,2016,5(1):151.
[30]Blaine KP,Sakai T.Viscoelastic monitoring to guide hemostatic resuscitation in liver transplantation surgery[J].Semin Cardiothorac Vasc Anesth,2018,22(2):150-163.
[31]Rolston JD,Han SJ,Lau CY,et al.Frequency and predictors of complications in neurological surgery:national trends from2006 to 2011[J].J Neurosurg,2014,120(3):736-745.
[32]McDonald MM,Wetzel J,Fraser S,et al.Thrombelastography does not predict clinical response to rtPA for acute ischemic stroke[J].J Thromb Thrombolysis,2016,41(3):505-510.
[33]Rao A,Lin A,Hilliard C,et al.The utility of thromboelastography for predicting the risk of progression of intracranial hemorrhage in traumatic brain injury patients[J].Neurosurgery,2017,64(CN_suppl_1):182-187.
[34]Ramchand P,Nyirjesy S,Frangos S,et al.Thromboelastography parameter predicts outcome after subarachnoid hemorrhage:an exploratory analysis[J].World Neurosurg,2016,96:215-221.
[35]Fontana P,Alberio L,Angelillo-Scherrer A,et al.Impact of rivaroxaban on point-of-care assays[J].Thromb Res,2017,153:65-70.
[36]Harahsheh Y,Ho KM.Use of viscoelastic tests to predict clinical thromboembolic events:a systematic review and meta-analysis[J].Eur J Haematol,2018,100(2):113-123.2018-12-12
[2]Whiting D,DiNardo JA.TEG and ROTEM:technology and clinical applications[J].Am J Hematol,2014,89(2):228-232.
[3]Winter WE,Flax SD,Harris NS.Coagulation testing in the core laboratory[J].Lab Med,2017,48(4):295-313.
[4]Solomon C,Collis RE,Collins PW.Haemostatic monitoring during postpartum haemorrhage and implications for management[J].Br J Anaesth,2012,109(6):851-863.
[5]Shreeve NE,Barry JA,Deutsch LR,et al.Changes in thromboelastography parameters in pregnancy,labor,and the immediate postpartum period[J].Int J Gynaecol Obstet,2016,134(3):290-293.
[6]Collis RE,Collins PW.Haemostatic management of obstetric haemorrhage[J].Anaesthesia,2015,70(Suppl 1):78-86,e27-e28.
[7]Jackson DL,DeLoughery TG.Postpartum hemorrhage:management of massive transfusion[J].Obstet Gynecol Surv,2018,73(7):418-422.
[8]American Society of Anesthesiologists Task Force on Perioperative Blood Management.Practice guidelines for perioperative blood management:an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management[J].Anesthesiology,2015,122(2):241-275.
[9]Chee YL,Greaves M.Role of coagulation testing in predicting bleeding risk[J].Hematol J,2003,4(6):373-378.
[10]Haas T,Fries D,Tanaka KA,et al.Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding:is there any evidence?[J].Br J Anaesth,2015,114(2):217-224.
[11]Karlsson O.Experience of point-of-care devices in obstetrical care[J].Semin Thromb Hemost,2017,43(4):397-406.
[12]Karlsson O,Jeppsson A,Hellgren M.Major obstetric haemorrhage:monitoring with thromboelastography,laboratory analyses or both?[J].Int J Obstet Anesth,2014,23(1):10-17.
[13]Gehrie EA,Baine I,Booth GS.Pathology consultation on viscoelastic studies of coagulopathic obstetrical patients[J].Am JClin Pathol,2016,146(2):149-155.
[14]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(2):D10438.
[15]Cohen MJ,Kutcher M,Redick B,et al.Clinical and mechanistic drivers of acute traumatic coagulopathy[J].J Trauma Acute Care Surg,2013,75(1 Suppl 1):S40-S47.
[16]Wirtz MR,Baumann HM,Klinkspoor JH,et al.Viscoelastic testing in trauma[J].Semin Thromb Hemost,2017,43(4):375-385.
[17]Gonzalez E,Moore EE,Moore HB.Management of trauma-induced coagulopathy with thrombelastography[J].Crit Care Clin,2017,33(1):119-134.
[18]Gonzalez E,Moore EE,Moore HB,et al.Goal-directed hemostatic resuscitation of trauma-induced coagulopathy:a pragmatic randomized clinical trial comparing a viscoelastic assay to conventional coagulation assays[J].Ann Surg,2016,263(6):1051-1059.
[19]Fahrendorff M,Oliveri RS,Johansson PI.The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products-a systematic review and meta-analysis[J].Scand J Trauma Resusc Emerg Med,2017,25(1):39.
[20]Whiting P,Al M,Westwood M,et al.Viscoelastic point-ofcare testing to assist with the diagnosis,management and monitoring of haemostasis:a systematic review and cost-effectiveness analysis[J].Health Technol Assess,2015,19(58):1-228.
[21]Willems A,Savan V,Faraoni D,et al.Heparin reversal after cardiopulmonary bypass:are point-of-care coagulation tests interchangeable?[J].J Cardiothorac Vasc Anesth,2016,30(5):1184-1189.
[22]Wikkels?A,Wetterslev J,Moller AM,et al.Thromboelastography(TEG)or thromboelastometry(ROTEM)to monitor haemostatic treatment versus usual care in adults or children with bleeding[J].Cochrane Database Syst Rev,2016(8):D7871.
[23]Wikkelsoe AJ,Afshari A,Wetterslev J,et al.Monitoring patients at risk of massive transfusion with Thrombelastography or Thromboelastometry:a systematic review[J].Acta Anaesthesiol Scand,2011,55(10):1174-1189.
[24]Deppe AC,Weber C,Zimmermann J,et al.Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery:a meta-analysis of 8332 patients[J].J Surg Res,2016,203(2):424-433.
[25]Lodewyks C,Heinrichs J,Grocott H P,et al.Point-of-care viscoelastic hemostatic testing in cardiac surgery patients:a systematic review and meta-analysis[J].Can J Anaesth,2018,65(12):1333-1347.
[26]Abeysundara L,Mallett SV,Clevenger B.Point-of-care testing in liver disease and liver surgery[J].Semin Thromb Hemost,2017,43(4):407-415.
[27]De Pietri L,Bianchini M,Montalti R,et al.Thrombelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy:a randomized,controlled trial[J].Hepatology,2016,63(2):566-573.
[28]Rocha LL,Pessoa CM,Neto AS,et al.Thromboelastometry versus standard coagulation tests versus restrictive protocol to guide blood transfusion prior to central venous catheterization in cirrhosis:study protocol for a randomized controlled trial[J].Trials,2017,18(1):85.
[29]McCrossin KE,Bramley DE,Hessian E,et al.Viscoelastic testing for hepatic surgery:a systematic review with meta-analysis-a protocol[J].Syst Rev,2016,5(1):151.
[30]Blaine KP,Sakai T.Viscoelastic monitoring to guide hemostatic resuscitation in liver transplantation surgery[J].Semin Cardiothorac Vasc Anesth,2018,22(2):150-163.
[31]Rolston JD,Han SJ,Lau CY,et al.Frequency and predictors of complications in neurological surgery:national trends from2006 to 2011[J].J Neurosurg,2014,120(3):736-745.
[32]McDonald MM,Wetzel J,Fraser S,et al.Thrombelastography does not predict clinical response to rtPA for acute ischemic stroke[J].J Thromb Thrombolysis,2016,41(3):505-510.
[33]Rao A,Lin A,Hilliard C,et al.The utility of thromboelastography for predicting the risk of progression of intracranial hemorrhage in traumatic brain injury patients[J].Neurosurgery,2017,64(CN_suppl_1):182-187.
[34]Ramchand P,Nyirjesy S,Frangos S,et al.Thromboelastography parameter predicts outcome after subarachnoid hemorrhage:an exploratory analysis[J].World Neurosurg,2016,96:215-221.
[35]Fontana P,Alberio L,Angelillo-Scherrer A,et al.Impact of rivaroxaban on point-of-care assays[J].Thromb Res,2017,153:65-70.
[36]Harahsheh Y,Ho KM.Use of viscoelastic tests to predict clinical thromboembolic events:a systematic review and meta-analysis[J].Eur J Haematol,2018,100(2):113-123.2018-12-12