血栓弹力图监测肝衰竭患者凝血功能的临床研究进展
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摘要
血栓弹力图(TEG)通过监测全血样本内所有凝血与抗凝物质,动态地评估凝血和纤溶全过程。肝脏是合成、降解促凝和抗凝物质的重要场所之一,在维持人体凝血-抗凝的稳态中发挥重要作用。肝衰竭患者由于肝细胞受损或坏死往往导致凝血功能障碍。然而,TEG检测结果提示肝衰竭患者中凝血与抗凝系统处于低水平的"再平衡"状态。肝衰竭患者经血浆置换、连续性血液净化等手段治疗后采用凝血常规检测法评估凝血功能存在较大干扰或限制,而TEG监测肝衰竭患者凝血功能状况更敏感、更全面,对于患者安全治疗的深度监测具有重要临床意义。本文对TEG的检测原理、检测类型、主要参数及其用于肝衰竭患者的凝血状态、在血浆置换和连续性血液净化中的应用研究进展进行了综述。
引文
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[16] 万克强,田文广,苏畅.血浆置换联合连续性血液滤过治疗肝衰竭前期临床分析[J].重庆医科大学学报,2018(1):52.
[17] 刘远志,李鹏,张月宁,等.TEG对比常规凝血检查在血浆置换和连续性血液净化治疗肝衰竭中的应用[J].医学研究杂志,2016,45(9):122.
[2] SANER F H,KIRCHNER C.Monitoring and treatment of coagulation disorders in end-stage liver disease[J]. Visc Med,2016,32(4):241.
[3] VALLA D,RAUTOU P.The coagulation system in patients with end-stage liver disease[J].Liver Int,2015,35(s1):139.
[4] 谭倩.血栓弹力图在评估肝硬化失代偿期患者凝血功能的价值[J].检验医学与临床,2018(13):2005.
[5] LUDDINGTON R J.Thrombelastography/thromboelastometry[J].Int J Lab Hematol,2010,27(2):81.
[6] 严广斌.血栓弹力图[J].中华关节外科杂志(电子版),2017,11(1):109.
[7] LAUBHAM M,KALLWITZ E.Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature[J].J Community Hosp Intern Med Perspect,2018,8(3):138.
[8] 李兰娟,段钟平.肝衰竭诊治指南(2012年版)[J].中华肝脏病杂志,2013,21(3):210.
[9] 付政文.止凝血功能指标在乙肝、肝硬化及肝衰竭患者中的变化规律[J].血栓与止血学,2017,23(4):609.
[10] 曾艳丽,高飞,魏君峰,等.血栓弹力图评价慢加急性肝衰竭患者的凝血功能及预后研究[J].中华肝脏病杂志,2017,25(1):32.
[11] STRAVITZ R T,LISMAN T,LUKETIC V A,et al.Minimal effects of acute liver injury/acute liver failure on hemostasis as assessed by thromboelastography[J].J Hepatol,2012,56(1):129.
[12] AGARWAL B,WRIGHT G,GATT A,et al.Evaluation of coagulation abnormalities in acute liver failure[J]. J Hepatol,2012,57(4):780.
[13] CHOUDHARY N S,SAIGAL S,SARAF N,et al.Good outcome of living donor liver transplantation in drug-induced acute liver failure: A single-center experience[J].Clin Transplant,2017,31(3):e12907.
[14] 刘鸿凌,辛绍杰,赵军,等.慢性重型肝炎患者连续性血液净化治疗过程中肝素对凝血功能的影响[J].传染病信息,2008,21(2):95.
[15] 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.
[16] 万克强,田文广,苏畅.血浆置换联合连续性血液滤过治疗肝衰竭前期临床分析[J].重庆医科大学学报,2018(1):52.
[17] 刘远志,李鹏,张月宁,等.TEG对比常规凝血检查在血浆置换和连续性血液净化治疗肝衰竭中的应用[J].医学研究杂志,2016,45(9):122.