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血栓弹力图在心胸外科围手术期的应用

ISSN号：1004-2806
期刊名称：《临床血液学杂志：输血与检验》
时间：0
分类：R457.1[医药卫生—治疗学;医药卫生—临床医学]
作者机构：[1]南京医科大学第一附属医院输血科,南京210029
相关基金：南京市科技计划项目资助（No：201303037）

关键词：血栓弹力图, 围手术期, 血小板功能异常, 冠心病, 血小板抑制率, thromboelastography, perioperative period, platelet dysfunction, CHD, platelet inhibition rate

中文摘要：

目的：评价血栓弹力图（TEG）在心胸外科围手术期的应用价值。方法：回顾分析101例心胸外科围手术期进行常规TEG的患者,其中14例在手术前、后均行TEG检查,9例仅在术前,78例仅在术后行TEG检查,共实施检测115次（术前23次,术后92次）;用TEG血小板图检测71例冠心病患者AA途径和ADP受体途径诱导的血小板抑制率,共实施检查102次（术前残留药效监测60次,术后药物疗效监测42次）。结果：术前有34.8%患者存在TEG异常,主要是纤维蛋白原缺乏;术后有79.3%患者发生TEG异常,主要原因依次为纤维蛋白原功能低下（50.0%）、肝素残留（42.4%）和血小板功能低下（32.6%）。与术前相比,术后患者表现为低凝,尤其是血小板功能明显降低（P〈0.05）。5例异常出血病例经TEG指导对症治疗无效,经开胸手术发现存在活动性出血。TEG血小板图监测冠心病患者阿司匹林和氯吡格雷的未显效率分别达到14.6%和16.7%;阿司匹林单独用药组与联合氯吡格雷用药组在血小板抑制率和临床治疗效果比较差异无统计学意义（P〉0.05）。结论：TEG有助于心胸外科围手术期患者凝血功能的评估和异常出血的诊断,同时对冠心病患者抗血小板个性化治疗具有指导作用。

英文摘要：

Objective：To analyze the usefulness of thromboelastography（TEG）in the perioperative period of cardiothoracic surgery.Method：A total of 101 patients who received TEG measurement perioperatively were analyzed retrospectively.There were 14 patients who received both pre-and postoperative TEG measurement.Nine patients were monitored preoperatively only,and 78 patients monitored postoperatively only.Total 115 TEG tests（including 23 tests performed preoperatively and 92 tests taken postoperatively）were accomplished.All TEG results,routine haemostatic assays such as APTT,PT,Fg,and platelet count were recorded.The platelet inhibition rate induced by AA and ADP ways of the 71 CHD patients was detected with Platelet Mapping assay,and total102 TEG tests（including 60 tests performed preoperatively and 42 tests taken postoperatively）were accomplished.Result：There were eight patients（34.8%）preoperatively with abnormal TEG results mainly because of low fibrinogen,and seventy-three patients（79.3 %）suffered from abnormal TEG postoperatively,including low fibrinogen（50.0%）,heparin residual（42.4%）and platelet dysfunction（32.6%）.Platelet function was decreased postoperatively compare to baseline（P〈0.05）.Most excessive bleeding patients had moderate to severe abnormal TEG results who were getting better after appropriate treatment,five patients not improving underwent re-exploration for bleeding and surgical bleeding were confirmed.By Platelet Mapping assay,14.6% of CHD patients taken aspirin and 16.7%taken clopidogrel were identified ineffective.Comparison of platelet inhibition rate induced by AA between aspirin group and aspirin combined with clopidogrel group was not significant（P〉0.05）.Conclusion：TEG test may be helpful for monitoring perioperative coagulation status and diagnosing excessive bleeding in cardiothoracic surgery and TEG could also guide the anti-platelet individual therapy for CHD patients.

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