国际麻醉学与复苏杂志   2019, Issue (8): 0-0
    
心脏手术患者围手术期血栓弹力图与凝血试验指标的相关性研究
呼家佳, 鄢建勤, 王锷, 张成梁1()
1.073189753478
Correlation between perioperative thromboelastogram and coagulation test in patients undergoing cardiac surgery
 全文:
摘要：

目的　探讨心脏手术患者CPB前后血栓弹力图（thromboelastography， TEG）与常规凝血试验及CPB相关参数之间相关性，研究TEG及凝血试验在心脏手术CPB前后的变化特点及其在心脏外科手术围手术期的应用价值。　方法　回顾性分析择期行CPB下心脏手术的患者手术前后TEG检测、常规凝血试验和血常规检测Hb浓度、血小板（blood platelet， PLT）计数。分析患者TEG检测中凝血反应时间（reaction time， R）值、血液凝固时间（clot time， K）值、凝固角（α-Angle， Angle）、最大振幅（maximum amplitude， MA）、凝血指数（coagulation index， CI）与凝血试验中凝血酶原时间（prothrombin time， PT）、国际标准比值（international standard ratio， INR）、活化部分凝血时间（activated partial coagulation time， APTT）、凝血酶时间（thrombin time， TT）、纤维蛋白原（fibrinogen， Fib）、Hb、PLT、CPB时间、主动脉阻断（aortic occlusion， OA）时间之间的相关关系。　结果　最终有47例患者纳入研究。术后K值及Fib较术前增加，差异有统计学意义（P＜0.05）；术后Hb和PLT较术前显著下降，差异有统计学意义（P＜0.05）。手术前（preoperation， pre）与手术后（postoperation， po）下列指标之间存在相关关系：MApre与PLTpre、INRpre与PTpre、Rpre与Kpre、Rpre与Anglepre、Rpre与CIpre、Kpre与Anglepre、Kpre与MApre、Kpre 与CIpre、Anglepre 与MApre、Anglepre 与CIpre、MApre与CIpre、Kpo与Kpre、Kpo与Anglepre、Kpo与MApre、Anglepo与Kpre、Anglepo与Anglepre、Anglepo与MApre、Anglepo与Kpo、CIpo与Rpo、CIpo与Kpo、CIpo与Anglepo、MApo与CPB、CPB与OA、Hbpo与Hbpre、PTpo与Hbpre、INRpo与Hbpre、INRpo与PTpo；在所有相关指标间，除Rpre与Anglepre、Rpre与CIpre、Kpre与Anglepre、Kpre与MApre、Kpre与CIpre、Kpo与Anglepre、Kpo与MApre、Anglepo与Kpre、Anglepo与Kpo、CIpo与Rpo、CIpo与Kpo、MApo与CPB、PTpo与Hbpre、INRpo与Hbpre为负相关外，其余均为正相关。　结论　CPB下心脏瓣膜手术患者术后TEG、凝血试验、Hb、PLT等检测指标之间存在广泛的相关关系，TEG与凝血试验对患者围手术期凝血功能监测都具有重要作用。
关键词： 心脏手术；　体外循环；　血栓弹力图；　凝血试验
Abstract:

Ｏｂｊｅｃｔｉｖｅ　To investigate the correlation among preoperative and postoperative thromboelastography (TEG) and routine coagulation tests in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB), and detect the changes of TEG and coagulation test pre-CPB and post-CPB and the values in perioperative management of cardiac surgery.　Methods　In the current study, TEG, routine coagulation test and platelet count of hemoglobin (Hb) and blood platelet (PLT) were measured before and after cardiac surgery under CPB. The correlation between reaction time (R), clotting time (K), α-Angle (Angle), maximum amplitude (MA), coagulation index (CI) and prothrombin time (PT), international standard ratio (INR), activated partial coagulation time (APTT), thrombin time (TT), fibrinogen (Fib), Hb, PLT, CPB time and aortic occlusion (OA) time was analyzed.　Results　Forty-seven patients were enrolled in the study. Postoperative K value and Fib were statistically significantly increased compared with the preoperative levels (P＜0.05). Postoperative Hb and PLT were decreased significantly compared with the preoperative levels (P＜0.05). The correlations analysis among pre-operation (pre) items and post-operation (po) items including TEG, routine coagulation test, Hb and PLT showed that correlations were existed in these following indicators: MApre and PLTpre, INRpre and PTpre, Rpre and Kpre, Rpre and Anglepre, Rpre and CIpre, Kpre and Anglepre, Kpre and MApre, Kpre and CIpre, Anglepre and MApre, Anglepre and CIpre, MApre and CIpre, Kpo and Kpre, Kpo and Anglepre, Kpo and MApre, Anglepo and Kpre, Anglepo and Anglepre, Anglepo and MApre, Anglepo and Kpo, CIpo and Rpo, CIpo and Kpo, CIpo and Anglepo, MApo and CPB, CPB and OA, Hbpo and Hbpre, PTpo and Hbpre, INRpo and Hbpre, INRpo and PTpo, among which Rpre and Anglepre, Rpre and CIpre,Kpre and Anglepre, Kpre and MApre, Kpre and CIpre, Kpo and Anglepre, Kpo and MApre, Anglepo and Kpre, Anglepo and Kpo, CIpo and Rpo, CIpo and Kpo, MApo and CPB, PTpo and Hbpre, INRpo and Hbpre were negatively correlated, and the others were positively correlated.　Conclusions　TEG, coagulation test, Hb and PLT are widely correlated after CPB in patients undergoing cardiac valve surgery. TEG and coagulation test play an important role in monitoring coagulation function during perioperative period.
Key words: Cardiac surgery;　Cardiopulmonary bypass; Thromboelastography;　Coagulation test