【摘要】：目的:探討血栓彈圖(TEG)在重癥多瓣膜病患者術(shù)后凝血功能評(píng)估及指導(dǎo)成分輸血、術(shù)后抗凝中的意義。方法:回顧性分析近5年成功進(jìn)行手術(shù)治療的62例重癥多瓣膜病患者,對(duì)比術(shù)前和術(shù)后1h和48h各項(xiàng)TEG檢測(cè)參數(shù)及傳統(tǒng)血常規(guī)和凝血機(jī)制檢測(cè)參數(shù),并將術(shù)后1h各項(xiàng)參數(shù)與術(shù)后輸注血漿、血小板和冷沉淀量進(jìn)行相關(guān)性分析。結(jié)果:術(shù)后1h的R值和K值明顯延長(zhǎng)(P0.05),術(shù)后1h的α-Angle值和MA值明顯減小(均P0.05),血常規(guī)顯示術(shù)后1h血小板(PLT)計(jì)數(shù)明顯降低(P0.05),傳統(tǒng)的凝血項(xiàng)檢測(cè)纖維蛋白原(FIB)術(shù)后1h明顯降低(P0.05),部分活化凝血酶原時(shí)間(APTT)、凝血酶原時(shí)間(PT)和INR值術(shù)后1h均明顯延長(zhǎng)(均P0.05)。Ly30(%)在手術(shù)后1h升高(P0.05),術(shù)后48h較術(shù)后無(wú)顯著差異。術(shù)后血漿輸注量與R值有顯著相關(guān)性(P0.05),血小板輸注量與MA和PLT計(jì)數(shù)有顯著相關(guān)性(均P0.05),冷沉淀輸注量與K值、α-Angle和APTT有顯著相關(guān)性(均P0.05)。結(jié)論:TEG可提示重癥多瓣膜病手術(shù)患者術(shù)后的凝血功能障礙,R值可以指導(dǎo)血漿的輸注,MA值可以指導(dǎo)血小板的輸注,K值、α-Angle可以作為術(shù)后冷沉淀輸注的重要參考,Ly30(%)在手術(shù)后1h升高提示繼發(fā)性纖溶功能亢進(jìn),術(shù)后48h較術(shù)后無(wú)顯著差異,提示患者凝血功能恢復(fù),應(yīng)給予華法林等抗凝藥物,預(yù)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(xué)應(yīng)用基礎(chǔ)研究聯(lián)合專(zhuān)項(xiàng)(No:2014FZ045)
【分類(lèi)號(hào)】：R654.2

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本文編號(hào)：2315164