Effect of monitoring and guiding blood transfusion by TEG on cardiac function and coagulation function
-
摘要: 目的 分析心外术后采用血栓弹力图(TEG)监测指导输血对心功能、凝血功能的影响。方法 回顾性纳入医院2021年4月—2023年5月收治的100例行心外科手术治疗患者为研究对象，根据不同指导输血方式将其划分为对照组(常规心功能、凝血功能监测指导输血)与研究组(TEG监测指导输血)，每组患者50例，分析输血前、输血24 h后对研究组患者TEG相关参数[凝血反应时间(R值)、凝血形成时间(K值)、凝血形成速率(α角)、凝血最大强度(MA)、凝血综合指数(CI)]的变化情况，比较不同指导模式下研究组与对照组间输血前及输血24 h后的心功能[左室收缩期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)]及凝血功能[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、凝血酶时间(TT)]。结果 ① 研究组采用TEG指导输血24 h后，TEG指标K、R更低，α、MA、CI更高，差异有统计学意义(P < 0.05)；②输血前研究组与对照组间LVEDD、LVESD、LVEF比较，差异无统计学意义(P>0.05)，输血24 h后，研究组与对照组LVEDD、LVESD均降低，LVEF均升高，组间比较差异有统计学意义(P < 0.05)，但研究组LVEF高于对照组，LVEDD、LVESD低于对照组，组间比较差异有统计学意义(P < 0.05)；③输血前研究组与对照组间TT、PT、APTT、FIB比较差异无统计学意义(P>0.05)，输血24 h后，研究组及对照组TT、PT、APTT均下降，FIB均上升，组间比较差异有统计学意义(P < 0.05)，但研究组TT、PT、APTT低于对照组，FIB高于对照组，组间比较差异有统计学意义(P < 0.05)。结论 相较于传统凝血功能监测模式，TEG能实现动态实时监测，心外术后采用TEG监测指导输血能显著提升患者的心功能水平、改善患者凝血功能，保障心外术后患者输血的安全性，建议临床推广使用。Abstract: Objective To analyze the effect of guiding blood transfusion on cardiac function and coagulation function.Methods A total of 100 patients admitted to cardiac surgery in our hospital from April 2021 to May 2023 were retrospectively included as the study object. According to different guiding blood transfusion methods, they were divided into control group (routine cardiac function and coagulation function monitor guide blood transfusion) and research group (thrombelastogram[TEG] monitor guide blood transfusion), of the 50 patients in each group. The TEG parameters of the study group were analyzed before and 24h after transfusion. The parameters were compared between study and control groups, including cardiac function (left ventricular end-diastolic diameter [LVEDD], left ventricular end-systolic diameter [LVESD], left ventricular ejection fraction [LVEF]) and coagulation function (prothrombin time[PT], activated partial thromboplastin time[APTT], fibrinogen[FIB], thrombin time[TT]).Results ① The study group performed TEG for 24 h after guiding blood transfusion, lower TEG indicators K, R, α, MA, and higher CI, statistically significant difference (P < 0.05); ②There was no statistical significance of LVEDD, LVESD and LVEF between the study group and the control group (P>0.05). After 24 h of blood transfusion, LVEDD and LVESD in the study group and the control group were both decreased, LVEF were both increased, there were statistical significance between the groups (P < 0.05). However, LVEDD and LVESD in the study group were lower than those in the control group, the LVEF in the study group was higher than that in the control group, and there were statistically significant between the groups (P < 0.05).③There was no statistical significance of TT, PT, APTT and FIB between the study group and the control group (P>0.05). After 24 h of blood transfusion, TT, PT and APTT decreased in the study and control groups, FIB both increased, and there was statistically significant difference (P < 0.05). However, TT, PT and APTT in the study group were lower than those in the control group, FIB was higher than that in the control group, and there was statistically significant between the groups (P < 0.05).Conclusion Compared with the traditional coagulation function monitoring mode, TEG guiding blood transfusion could realize dynamic real-time monitoring, significantly improve the cardiac function level and coagulation function of patients, and ensure the safety of blood transfusion in patients after extracardiac surgery.
-
Key words:
- extracardiac surgery /
- thrombelastogram /
- blood transfusion /
- cardiac function /
- coagulation function
-
-
表 1 患者组间基线资料比较
组别 研究组(n=50) 对照组(n=50) χ2/F P 性别/例(%) 1.105 0.161 男 33(66.00) 31(62.00) 女 17(34.00) 19(38.00) 年龄/岁 0.963 0.171 年龄范围 40~76 43~74 平均年龄 57.72±6.32 56.49±7.04 合并基础性疾病/例(%) 1.032 0.139 高血压 26(52.00) 27(54.00) 糖尿病 19(38.00) 21(42.00) 高血脂 17(34.00) 16(32.00) BMI/(kg/m2) 0.934 0.179 BMI范围 20.67~29.06 21.24~28.97 平均BMI 24.61±2.32 25.83±1.17 手术时间/min 0.896 0.192 时间范围 147~252 139~267 平均时间 204.52±9.63 203.61±10.82 
下载: 导出CSV
表 2 研究组输血前后TEG参数变化情况比较
X±S 时间 K/min R/min α/° MA/min CI 输血前 4.21±0.79 7.56±1.21 50.69±9.72 43.93±7.67 -3.57±0.46 输血24 h后 2.71±0.69 5.76±1.04 65.42±10.66 55.67±9.93 1.31±0.47 t 5.637 5.325 4.127 4.153 6.694 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
下载: 导出CSV
表 3 研究组与对照组输血前后心功能水平比较
X±S 组别 LVEDD/mm LVESD/mm LVEF/% 输血前 输血24 h后 输血前 输血24 h后 输血前 输血24 h后 研究组(n=50) 62.53±4.35 52.58±4.041)2) 52.72±3.58 41.78±2.191)2) 33.23±4.17 51.21±5.971)2) 对照组(n=50) 62.8±4.17 57.71±3.851) 51.67±4.95 46.54±2.691) 33.63±4.27 43.07±6.941) t 0.643 5.144 0.106 5.679 0.598 7.454 P 0.557 < 0.001 0.941 < 0.001 0.613 < 0.001 与输血前比较，1)P < 0.05；与对照组比较，2)P < 0.05。
下载: 导出CSV
表 4 研究组与对照组输血前后凝血功能指标变化情况比较
X±S 组别 TT/s PT/s APTT/s FIB/(g/L) 输血前 输血24 h后 输血前 输血24 h后 输血前 输血24 h后 输血前 输血24 h后 研究组(n=50) 26.53± 3.35 18.58± 3.041)2) 18.72± 3.58 12.78± 2.191)2) 41.23± 7.17 30.21± 4.971)2) 1.67± 0.17 3.65± 1.341)2) 对照组(n=50) 26.86± 3.17 22.71± 4.851) 18.67± 2.95 15.54± 3.691) 40.63± 8.27 34.07± 4.941) 1.79± 0.16 2.51± 0.631) t 0.663 5.126 0.675 4.335 1.098 9.454 0.653 4.631 P 0.591 < 0.001 0.562 < 0.001 0.216 < 0.001 0.587 < 0.001 与输血前比较，1)P < 0.05；与对照组比较，2)P < 0.05。
下载: 导出CSV
-
[1] Mandour A, Arafat A, Elatafy E, et al. The effect of topical application of platelet-rich plasma in controlling bleeding and sternotomy wound infection after cardiac surgery[J]. Tanta Med J, 2019, 47(3): 139. doi: 10.4103/tmj.tmj_11_19
[2] 王薇, 李勇. 血栓弹力图监测不稳定性心绞痛合并阻塞性睡眠呼吸暂停综合征患者抗血小板药物的反应性[J]. 中国医药导报, 2014, 11(5): 44-46. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201405016.htm
[3] 杨洋, 宋辛叶, 栾永. 应用血栓弹力图探讨不同比例鱼精蛋白中和肝素对体外循环心脏手术后出凝血的影响[J]. 实用医学杂志, 2020, 36(21): 2926-2930. doi: 10.3969/j.issn.1006-5725.2020.21.008
[4] Pickard AL, Hudson A, Sabri O. The use of 'viscoelastic tests' in driving transfusion needs in major trauma patients[J]. Orthopaedics and Trauma, 2021, 35(3): 361-363, 366.
[5] 赵水平, 胡大一. 心血管病诊疗指南解读[M]. 北京: 人民卫生出版社, 2004: 4-16.
[6] 徐静. 血栓弹力图监测静脉溶栓患者凝血状态的临床指导价值分析[J]. 实用中西医结合临床, 2021, 21(19): 120-121, 125.
[7] 钱姣, 杨丹丹, 苏杜娟, 等. 血栓弹力图监测不同流产次数的复发性流产患者凝血功能变化情况[J]. 贵州医药, 2020, 44(11): 1800-1801. doi: 10.3969/j.issn.1000-744X.2020.11.059
[8] 吴家顺, 周婧, 陈会欣, 等. 基于血栓弹力图监测下的脑梗死患者阿司匹林低反应与中医体质关系研究[J]. 湖北中医药大学学报, 2023, 25(2): 99-101. https://www.cnki.com.cn/Article/CJFDTOTAL-HZXX202302027.htm
[9] 陈瑜, 温燕华, 邱芳, 等. 血栓弹力图在冠状动脉旁路移植术个体化成分输血的应用价值分析[J]. 临床血液学杂志, 2023, 36(10): 751-754. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2023.10.013
[10] 饶欣, 闫寒. 血栓弹力图参数预测急诊重症颅脑损伤患者并消化道出血的研究[J]. 临床急诊杂志, 2023, 24(7): 335-339. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202307001.htm
[11] 赵郑, 李哲, 王华玲. 血栓弹力图检查对外科手术患者凝血监测及出血量预测的价值[J]. 实验与检验医学, 2020, 38(5): 987-990. doi: 10.3969/j.issn.1674-1129.2020.05.053
[12] 徐君茹, 陈科利, 高建. 血栓弹力图对肝硬化伴门静脉血栓预测价值的研究[J]. 重庆医学, 2022, 51(17): 2955-2960. doi: 10.3969/j.issn.1671-8348.2022.17.017
[13] 张其俊, 何爱文. 血栓弹力图仪在危重症创伤出血患者凝血功能监测的应用及对临床输血治疗的指导[J]. 浙江创伤外科, 2018, 23(4): 741-743. doi: 10.3969/j.issn.1009-7147.2018.04.055
[14] Daane CR, Golab HD, Meeder JH, et al. Processing and transfusion of residual cardiopulmonary bypass volume: effects on haemostasis, complement activation, postoperative blood loss and transfusion volume[J]. Perfusion, 2003, 18(2): 115-121. doi: 10.1191/0267659103pf647oa
[15] 姚超峰, 李会广. 大量输血方案对急性创伤患者凝血功能纤溶功能及血栓弹力图监测结果的影响[J]. 中国药物与临床, 2021, 21(6): 992-994. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202106047.htm
[16] 黄媛, 陈水平, 宋世平, 等. 血栓弹力图法与光学比浊法监测冠心病患者阿司匹林抵抗的效果比较[J]. 检验医学与临床, 2014, 11(23): 3277-3278, 3281. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL201423018.htm
[17] Kachel E, Constantini K, Nachman D, et al. A pilot study of blood pressure monitoring after cardiac surgery using a wearable, non-invasive sensor[J]. Front Med, 2021, 8: 693926. http://www.socolar.com/Article/Index?aid=100089868058&jid=100000000186
[18] 詹晓燕, 林玉蓓, 胡杰, 等. 血栓弹力图监测冠心病患者PCI术后替格瑞洛和氯吡格雷抗血小板治疗效果研究[J]. 中国循证心血管医学杂志, 2017, 9(9): 1108-1111. https://www.cnki.com.cn/Article/CJFDTOTAL-PZXX201709032.htm
[19] Differding JA, Underwood SJ, van PY, et al. Trauma induces a hypercoagulable state that is resistant to hypothermia as measured by thrombelastogram[J]. Am J Surg, 2011, 201(5): 587-591.
[20] 李双涛, 杨京灵, 吕红艳, 等. 创伤性失血病人输血前后血细胞比容和酸碱度变化及其与凝血功能的关系分析[J]. 蚌埠医学院学报, 2023, 48(7): 941-946. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG202307020.htm
[21] Wang F J. Study on the Guidance of Platelet Inhibition Rate Detected with Thrombelastogram in Antiplatelet Therapy for Acute Non-Cardiogenic Stroke[J]. Clinical nursing research, 2022, 6(5): 40-44.
[22] 潘锡红, 陈丽华, 赖鹏飞, 等. 急重型颅脑损伤凝血功能障碍患者围手术期血栓弹力图监测的临床意义[J]. 黑龙江医药, 2021, 34(5): 1015-1018. https://www.cnki.com.cn/Article/CJFDTOTAL-HJYY202105009.htm
[23] 王潇翊, 王鑫, 杨柳. 血栓弹力图联合凝血功能检测在创伤患者输血治疗中的指导作用评估[J]. 四川生理科学杂志, 2023, 9(5): 859-861.
[24] 孟凯, 李晓亚, 王安祥. 血栓弹力图指导下输血及监测肝素是否残留对心外术后心功能的影响[J]. 湖南师范大学学报(医学版), 2022, 19(1): 262-265. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYG202201074.htm
-
计量
- 文章访问数: 222
- 施引文献: 0