發(fā)布時間：2018-11-06 18:53

【摘要】：目的:探討血栓彈圖(TEG)在重癥多瓣膜病患者術后凝血功能評估及指導成分輸血、術后抗凝中的意義。方法:回顧性分析近5年成功進行手術治療的62例重癥多瓣膜病患者,對比術前和術后1h和48h各項TEG檢測參數及傳統(tǒng)血常規(guī)和凝血機制檢測參數,并將術后1h各項參數與術后輸注血漿、血小板和冷沉淀量進行相關性分析。結果:術后1h的R值和K值明顯延長(P0.05),術后1h的α-Angle值和MA值明顯減小(均P0.05),血常規(guī)顯示術后1h血小板(PLT)計數明顯降低(P0.05),傳統(tǒng)的凝血項檢測纖維蛋白原(FIB)術后1h明顯降低(P0.05),部分活化凝血酶原時間(APTT)、凝血酶原時間(PT)和INR值術后1h均明顯延長(均P0.05)。Ly30(%)在手術后1h升高(P0.05),術后48h較術后無顯著差異。術后血漿輸注量與R值有顯著相關性(P0.05),血小板輸注量與MA和PLT計數有顯著相關性(均P0.05),冷沉淀輸注量與K值、α-Angle和APTT有顯著相關性(均P0.05)。結論:TEG可提示重癥多瓣膜病手術患者術后的凝血功能障礙,R值可以指導血漿的輸注,MA值可以指導血小板的輸注,K值、α-Angle可以作為術后冷沉淀輸注的重要參考,Ly30(%)在手術后1h升高提示繼發(fā)性纖溶功能亢進,術后48h較術后無顯著差異,提示患者凝血功能恢復,應給予華法林等抗凝藥物,預防血栓形成。
[Abstract]:Objective: to investigate the significance of thromboelastography (TEG) in evaluating postoperative coagulation function and guiding blood component transfusion and anticoagulant after operation in patients with severe multi-valvular disease. Methods: 62 patients with severe polyvalvular disease who were successfully operated in recent 5 years were analyzed retrospectively. The parameters of TEG, traditional blood routine and coagulation mechanism were compared before and 1 and 48 hours after operation. The correlation of the parameters with plasma, platelet and cryoprecipitation was analyzed. Results: the values of R and K were significantly prolonged at 1 hour after operation (P0.05), 偽-Angle and MA were significantly decreased at 1 hour after operation (P0.05), and the platelet (PLT) count was significantly decreased at 1 hour after operation (P0.05). The traditional thromboplastin test for fibrinogen (FIB) decreased significantly 1 hour after operation (P0.05), and partially activated prothrombin time (APTT),). Prothrombin time (PT) and prothrombin INR (INR) were significantly prolonged 1 hour after operation (P0.05). Ly30 (%) increased 1 hour after operation (P0.05), but there was no significant difference between 48 hours after operation and 48 hours after operation. There was a significant correlation between plasma infusion volume and R value (P0.05), platelet infusion volume with MA and PLT count (P0.05), cryoprecipitation infusion volume and K value, 偽 -Angle and APTT (P0.05). Conclusion: TEG can indicate the postoperative coagulation dysfunction in patients with severe multi-valvular disease, R value can guide plasma infusion, MA value can guide platelet infusion, K value and 偽-Angle can be used as an important reference for cryoprecipitation infusion after operation. The increase of Ly30 (%) at 1h after operation suggested secondary hyperfibrinolysis, but there was no significant difference at 48h after operation. It suggested that the coagulation function of the patients recovered, so warfarin and other anticoagulants should be given to prevent thrombosis.
【作者單位】： 云南省第二人民醫(yī)院;
【基金】：云南省科技廳-昆明醫(yī)科大學應用基礎研究聯合專項(No:2014FZ045)
【分類號】：R654.2

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