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  本文關鍵詞： 血栓彈力圖 參考區(qū)間 凝血 血栓彈力圖 心臟瓣膜假體植入 輸血　出處：《安徽醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的建立安徽漢族健康成年人群高嶺土-血栓彈力圖的參考區(qū)間。方法依據美國臨床和實驗室標準化協(xié)會(CLSI)C28-A3的文件規(guī)范,采用高嶺土-血栓彈力圖測定1681例安徽地區(qū)18~65歲的漢族健康成年人的凝血功能,對所取樣本進行性別、年齡分組比較,以非參數百分位數法計算目標人群血栓彈力圖的參考區(qū)間。結果安徽地區(qū)漢族健康成年人群的高嶺土-血栓彈力圖參考區(qū)間男性為:R:4.2 8.7min、K:1.2 3.2 min、Angle:47.0 72.3°、MA:49.1 70.5 mm;女性為:R:3.7 9.0 min、K:1.0 3.2 min、Angle:48.4 74.4°、MA:46.8 72.4 mm。而通過分組比較發(fā)現,在女性組和高齡組人群中所測得的血栓彈力圖參數均提示其血液呈相對高凝狀態(tài)。結論本研究依據規(guī)范建立了安徽漢族健康成年人群血栓彈力圖的參考區(qū)間,可為臨床和實驗室的相關研究提供參考。目的探討血栓彈力圖在成人心臟瓣膜置換術后于ICU期間監(jiān)測血凝及指導輸血的應用價值。方法回顧分析經體外循環(huán)行心臟瓣膜置換手術的118例成人患者,依據指導患者術后在ICU期間輸血的止凝血檢測方法不同,分為血栓彈力圖組(TEG組)62例與標準凝血試驗組(SCT組)56例,對兩組間人口統(tǒng)計學特征、術前止凝血功能、術中血液出入量的差異進行比較,同時統(tǒng)計分析兩組患者于ICU期間的引流量與血制品輸注情況及氣管插管時間、住ICU時間等指標。結果兩組患者人口統(tǒng)計學特征、心功能分級、術前止凝血功能無差別(P0.05),術中各類型血制品平均輸注量無統(tǒng)計差異(P0.05)。與SCT組相比,TEG組患者術后于ICU期間血漿輸注量顯著減少(P0.01),血小板輸注量雖未達統(tǒng)計學差異水平但有明顯減少(P=0.086),兩組紅細胞輸注量無差別(P0.05)。未發(fā)現兩組患者間短期轉歸指標如引流量、氣管插管時間、住ICU時間及ICU后出院時間等存在明顯區(qū)別(P0.05)。結論可以運用TEG來監(jiān)測成人患者心臟換瓣手術后的止凝血功能并且指導輸血,它對患者術后轉歸無明顯影響的同時可減少血漿與血小板的使用量,這對精準輸血具有重要意義。
[Abstract]:Objective to establish the reference interval of kaolin thromboelastic map in healthy adult population of Anhui Han nationality. Methods according to the document specification of CLSIC28-A3, the American Association of Clinical and Laboratory Standardization, The clotting function of 1681 healthy Han nationality adults aged 18 to 65 years old in Anhui area was measured by kaolin thromboelastography. The sex and age groups of the samples were compared. Results the reference interval of kaoline-thromboelastic map for healthy adults of Han nationality in Anhui area was calculated by non-parametric percentile method. Results the reference interval of Kaolin and thromboelastic map for healthy adults in Anhui area was: 1: r: 4.2 + 8.7min K: 1.2 + 3.2 min Angle: 47.0 / 72.3 擄/ MA: 49.1 / 70.5 mm; female =: R3.7 = 9.0 min / K: 1.0. 3. 2 min Angle: 48.4 / 74.4 擄/ MAW 46.8 / 72.4 mm. and compared with each other, The parameters of thromboelastogram in both female and elderly population indicated that the blood was relatively hypercoagulable. Conclusion the reference interval of thromboelastogram in healthy adult population of Anhui Han nationality was established according to the criterion. Objective to explore the value of thromboelastography in monitoring hemagglutination and guiding blood transfusion during ICU after cardiac valve replacement in adults. 118 adult patients undergoing visceral valve replacement, According to the different methods of blood transfusion during ICU, the patients were divided into thromboelastogram group (62 cases) and standard coagulation test group (56 cases). The difference of blood volume during operation was compared, and the drainage volume, transfusion of blood products, time of endotracheal intubation and ICU duration during ICU were statistically analyzed in the two groups. Results the demographic characteristics and cardiac function grading of the two groups were analyzed. There was no significant difference in blood coagulation function before operation (P 0.05), and there was no statistical difference in the average volume of blood products during operation. Compared with SCT group, plasma infusion volume decreased significantly during ICU period, and platelet transfusion volume did not reach statistical difference. There was no significant difference in erythrocyte infusion volume between the two groups (P 0.05). There were significant differences in tracheal intubation time, ICU stay time and discharge time after ICU. Conclusion TEG can be used to monitor the anticoagulant function of adult patients after cardiac valve replacement and to guide blood transfusion. It can reduce the use of plasma and platelet, which is of great significance for accurate blood transfusion.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654.2;R446.11

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