發(fā)布時(shí)間：2019-06-24 11:44

【摘要】：目的通過血栓彈力圖(TEG)的分析,對(duì)體外循環(huán)心臟直視手術(shù)患者圍術(shù)期凝血功能的變化進(jìn)行初步研究。通過TEG的監(jiān)測(cè),比較瓣膜置換手術(shù)、先天性心臟病矯治手術(shù)及主動(dòng)脈大血管手術(shù)三種手術(shù)類型對(duì)患者凝血功能影響有無不同,評(píng)估TEG在體外循環(huán)手術(shù)中的監(jiān)測(cè)意義。方法選擇2015年11月至2017年3月在煤炭總醫(yī)院心臟中心明確診斷需行擇期體外循環(huán)心臟直視手術(shù)的患者34例。按術(shù)式分為瓣膜置換手術(shù)組(A組),先天性心臟病矯治手術(shù)組(B組),大血管手術(shù)組(C組)。所有患者均在全身靜脈吸入復(fù)合麻醉、體外循環(huán)心臟直視下進(jìn)行手術(shù)。選用西芬斯LEPU-8800血栓彈力圖儀進(jìn)行TEG檢測(cè),對(duì)所獲得病例的數(shù)據(jù)進(jìn)行及時(shí)整理、記錄并分類統(tǒng)計(jì)。結(jié)果1.各組例數(shù)及所占比分別為17例(50.00%)、15例(44.12%)、2例(5.88%)。比較三組患者的臨床基本資料,差異無統(tǒng)計(jì)學(xué)意義(P0.05);2.體外循環(huán)心臟直視手術(shù)前后患者血紅蛋白及血小板存在顯著差異(P=0.000);體外循環(huán)心臟直視手術(shù)后血栓彈力圖普通杯中R值與K值較術(shù)前值升高,α-Angle角、MA值及CI值較之術(shù)前值則有所降低;術(shù)后血栓彈力圖肝素酶杯中R值、K值和MA值較術(shù)后普通杯值下降,α-Angle角和CI值則較之普通杯值有所升高;術(shù)后血栓彈力圖肝素酶杯中R值、K值較術(shù)前普通杯值上升,α-Angle角、MA值和CI值則較之普通杯值有所下降;3.體外循環(huán)心臟直視手術(shù)不同術(shù)式之間術(shù)前普通杯R值、K值、α-Angle角、MA值及CI值無統(tǒng)計(jì)學(xué)差異(P0.05);不同術(shù)式之間術(shù)后普通杯與術(shù)后肝素酶杯的R值、K值、α-Angle角、MA值及CI值存在統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1.體外循環(huán)后,患者TEG提示患者凝血功能減弱。2瓣膜置換手術(shù)、先天性心臟病矯治手術(shù)及大血管手術(shù)三種術(shù)式手術(shù)前后TEG改變不同。3.TEG可以評(píng)估患者凝血功能,是一種便捷有效的方法。
[Abstract]:Objective To study the changes of blood coagulation function in patients undergoing open heart surgery with cardiopulmonary bypass (TEG). The effects of three types of operation types on the coagulation function of the patients were compared with the three types of operation types, such as valve replacement, congenital heart disease, and aortic large-vessel operation, and the monitoring significance of TEG in the operation of cardiopulmonary bypass was evaluated. Methods Thirty-four patients with open heart surgery were selected from November 2015 to March 2017 at the heart center of the General Hospital of the Coal General Hospital. The operation procedure was divided into three groups: group A, group B, and group C. All patients were given a combination of anesthesia with the whole body, and the operation was performed under the open heart. The data of the obtained cases were sorted, recorded and classified according to the TEG test by using the Sphens LEPU-8800 thromboelastograph. Results 1. The number and proportion of each group were 17 (50.00%),15 (44.12%) and 2 (5.88%), respectively. There was no significant difference in the clinical basic data of the three groups (P0.05). There was a significant difference in hemoglobin and platelet in the patients before and after the open heart surgery (P = 0.000), and the value of R and K in the normal cup was higher than the pre-operative value of the normal cup after the open heart operation. The value of R-value, K-value and MA-value of the post-operative thromboelastogram were lower than that of the common cup after operation. The value of R-Angle and CI was higher than that of the common cup. The value of R-value and K-value in the heparin-enzyme cup after operation was higher than that of the normal cup before operation. The MA value and the CI value decrease compared to the normal cup value;3. There was no statistical difference between the value of the common cup (R), the K value, the angle of the knee-Angle, the MA value and the value of the CI (P0.05). The R value, the K value, the angle of the K-Angle of the common cup and the post-operative heparin-enzyme cup between different operation methods were not statistically different (P0.05). There was a statistical difference between the values of MA and CI (P0.05). Conclusion 1. After the cardiopulmonary bypass, the patient's TEG suggested that the coagulation function of the patient was weakened. The changes of the TEG before and after the operation of valve replacement, the treatment of congenital heart disease and the operation of the large blood vessel were different.3. The TEG can evaluate the coagulation function of the patient, and it is a convenient and effective method.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.2

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