目的 观察分析血栓弹力图（TEG）在成人心脏瓣膜置换术后凝血功能的监测和指导输血的应用价值.方法 选取63例行心脏瓣膜置换术的成人患者为研究对象,根据患者术后在ICU凝血功能监测方式的不同将63例患者分为TGE组和标准凝血试验组（即SCT组）.比较两组术前凝血功能,记录术中血液出血量及输血量,分析比较两组在ICU期间的血液输注情况、引流量、气管插管情况,以及入住ICU时间.结果 比较两组患者术前血液检查结果,两组各项指标比较未见统计学差异（P＞0.05）.SCT组ICU期间输FFP量为（244±184）ml、转出ICU 2 h前APTT为（31.1±5.8）s、FIB为（5.43±1.97）g/L、D-二聚体为（7.31±6.91）mg/L、AT-Ⅲ为（104.0±19.5）％;TEG组ICU期间输FFP量为（134±174）ml、转出ICU2 h前APTT为（34.7±5.6）s、FIB为（3.57±1.17）g/L、D-二聚体为（3.71±3.31）mg/L、AT-Ⅲ为（94.1±14.7）％,两组比较差异有统计学意义（P＜0.05）,其他指标比较未见统计学差异（P＞0.05）.SCT组的手术时间、体外循环时间、短期转归指标与TEG组比较未见统计学差异（P＞0.05）.结论 TEG可用于成人心脏瓣膜置换术后凝血功能的监测及输血的指导,不仅可以减少FFP、PLT的用量和精确输血,还不影响转归.
Objective To study the value of TEG applying to the adults＇ coagulation and guiding the clinical blood transfusion after cardiac valve replacement. Methods 63 patients who had been given cardiac valve replacement were selected as the study objectives. According to the patients＇ coagulation ways in the ICU after surgery, they were divided into TEG group and SCT group. Before the surgery, the coagulation condition between both groups were compared. The blood volum in loss and transfusion were recorded. The blood products transfusion condition, drainage volume, trachea cannula condition and length of hospital stay during the ICU period were analyzed and compared. Results Comparing the results of preoperative blood tests between the two groups, there was no significant difference between the two groups （P〉0.05）. In the SCT group, the FFP volume during the ICU was （244±184）ml, the APTT before the ICU 2 h was （31.1±5.8）s, the FIB was （5.43±1.97）g/L, and the D-dimer was （ 7.31 ±6.91 ） mg/L and AT-Ⅲ were （ 104.0± 19.5 ） % ; the amount of FFP delivered during the ICU of the TEG group was （ 134±174）ml, the APTT before the ICU was transferred 2 h was （34.7±5.6）s, the FIB was （3.57±1.17）g/L, D-dimer were （3.71±3.31）mg/L and AT-Ⅲ was （94.1±14.7）%. There was a statistically significant difference between the two groups （P〈0.05）. No statistical significance （P〉0.05）. There was no signifi- cant difference in the operation time, cardiopulmonary bypass time, and short-term outcome between the SCT group and the TEG group（P〉0.05 ）. Conclusion TEG applying to the adults＇ coagulation and guiding the clinical blood transfusion after cardiac valve replacement not only decrease the amount of FFP and PLT and amount of transfusion, but also does no impact on the outcome.
Chinese Journal of Cardiovascular Review