Analysis of application value of thromboelastography in individualized component blood transfusion in coronary artery bypass grafting
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摘要: 目的 探讨血栓弹力图(TEG)在冠状动脉旁路移植术个体化成分输血的应用价值。方法 选择2018—2020年入院行冠状动脉旁路移植术的患者，分为TEG指导组(TEG组)及传统常规凝血指导组(CCT组)，每组随机抽取50例。比较2组患者围术期中红细胞(RBC)、冰冻血浆(FP)、血小板(PLT)、冷沉淀(CRY)输血量及输血不良反应发生率、再次手术率的差异。结果 TEG组及CCT组各血液成分的输血量比较，2组RBC输注总量差异无统计学意义(P>0.05)；TEG组PLT、FP、CRY各输注总量均少于CCT组，差异有统计学意义(P < 0.05)；TEG组输血不良反应发生率较CCT组明显减少(P < 0.05)；2组间再次手术率差异无统计学意义(P>0.05)。结论 TEG在冠状动脉旁路移植术个体化成分输血中，可通过合理调整输注剂量，提高输血治疗的有效性、安全性，降低输血不良反应，节约临床用血。Abstract: Objective To investigate the application value of thromboelastogram(TEG) in individual component transfusion in coronary artery bypass grafting.Methods The patients who were admitted to our hospital for coronary artery bypass grafting from 2018 to 2020 were divided into TEG guidance group(TEG group) and conventional coagulation guidance group(CCT group). A total of 50 patients were randomly selected from each group. The blood transfusion volume of red blood cell(RBC), frozen plasma(FP), platelet(PLT), cryoprecipitate(CRY), the incidence of adverse blood transfusion reaction and the reoperation rate were compared between the two groups.Results There was no significant difference in the total amount of RBC transfusion between TEG group and CCT group(P>0.05). The total amount of PLT, FP and CRY transfusion in TEG group was less than those in CCT group, with statistically significant difference(P < 0.05). The incidence of adverse transfusion reactions in TEG group was significantly lower than that in CCT group(P < 0.05). There was no significant difference in reoperation rate between the two groups(P>0.05).Conclusion TEG in individual component transfusion of coronary artery bypass grafting could improve the effectiveness and safety of transfusion therapy, reduce the adverse reactions of transfusion and save the clinical use of blood by adjusting the infusion dose reasonably.
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表 1 TEG组与CCT组一般资料比较
项目 TEG组(n=50) CCT组(n=50) P 年龄/岁 65.72±7.02 64.23±7.01 0.756 男/女 23/27 24/26 0.558 BMI 24.52±3.02 24.25±3.20 0.526 手术时间/h 4.40±0.75 4.31±0.81 0.752 
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表 2 2组患者术前术后实验室数据比较
指标 术前 术后 CCT组 TEG组 P CCT组 TEG组 P Hb/(g/L) 118.3±17.2 120.4±15.2 0.45 72.0±0.5 102.0±0.5 0.75 HCT/% 38.0±4.2 39.0±5.0 0.29 25.0±3.2 29.0±6.0 0.42 PLT/(×109/L) 145.0±56.2 152.0±42.3 0.62 63.0±0.3 98.0±0.4 0.01 PT/s 11.4(10.2，11.9) 10.9(10.6，11.5) 0.08 13.5(10.2，19.2) 12.2(9.2，18.7) 0.42 APTT/s 32.8(30.0，38.2) 33.0(30.0，37.2) 0.55 42.2(37.0，52.2) 40.2(38.5，45.2) 0.55 FIB/(g/L) 3.9±0.2 4.0±0.2 0.75 4.2±0.2 3.9±0.2 0.44 INR 1.8(1.3, 2.7) 1.9(1.4, 2.6) 0.46 1.7(1.5, 2.0) 2.0(1.7, 2.3) 0.01
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表 3 TEG组与CCT组血液制品输注量比较
项目 TEG组 CCT组 P RBC/U 4.58±0.20 4.52±0.42 0.958 FP/mL 200.00 (200.00，400.00) 500.00 (400.00，1 000.00) ＜0.001 PLT/U 1.62±0.32 1.89±0.54 0.025 CRY/U 13.58±4.28 26.75±2.48 ＜0.001
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