CAJ | 학술논문

目的术后出血是腹部外科围手术期常见的并发症之一,及时准确评估输血量对患者的预后至关重要.本研究主要观察血栓弹力图(TEG)与生命体征、尿量、血红蛋白、红细胞压积等传统指标相比,能否准确评估输血量.方法观察2010年6月至2010年12月之间术后回监护病房后怀疑有出血的57例患者.记录相关数据,包括生命体征(平均动脉压、心率、呼吸频率、脉氧)、每小时尿量、血常规(Hb、Hct、Plt)、传统凝血试验指标(Fib、PT、aPTT、INR)、TEG参数(R、K、Angle、MA、CI)及术后有无出血、24 h输血量.结果术后生命体征、小时尿量、血常规(Hb、Hct、Plt)、传统凝血试验(Fib、PT、INR)与输血量差异均无统计学意义,但是aPTT(R=0.513,P=0.000)和MA值(R=0.578,P=0.000)与输血量之间差异有统计学意义,其中MA值越低输血量越多.根据有无活动性出血将患者分为两组,活动性出血组和非活动性出血组,两组MA值差异有统计学意义(P =0.025),而aPTT差异无统计学意义.结论 TEG能准确评估腹部术后出血的输血量,尤其是活动性出血.
목적 술후출혈시복부외과위수술기상견적병발증지일,급시준학평고수혈량대환자적예후지관중요.본연구주요관찰혈전탄력도(TEG)여생명체정、뇨량、혈홍단백、홍세포압적등전통지표상비,능부준학평고수혈량.방법 관찰2010년6월지2010년12월지간술후회감호병방후부의유출혈적57례환자.기록상관수거,포괄생명체정(평균동맥압、심솔、호흡빈솔、맥양)、매소시뇨량、혈상규(Hb、Hct、Plt)、전통응혈시험지표(Fib、PT、aPTT、INR)、TEG삼수(R、K、Angle、MA、CI)급술후유무출혈、24 h수혈량.결과 술후생명체정、소시뇨량、혈상규(Hb、Hct、Plt)、전통응혈시험(Fib、PT、INR)여수혈량차이균무통계학의의,단시aPTT(R=0.513,P=0.000)화MA치(R=0.578,P=0.000)여수혈량지간차이유통계학의의,기중MA치월저수혈량월다.근거유무활동성출혈장환자분위량조,활동성출혈조화비활동성출혈조,량조MA치차이유통계학의의(P =0.025),이aPTT차이무통계학의의.결론 TEG능준학평고복부술후출혈적수혈량,우기시활동성출혈.
Objective To investigate the accuracy and promptness of thromboelastography (TEG) to assess the blood transfusion requirements after abdominal operation in comparison with conventional assessments including vital signs (MAP,heart rate,breathing rate),urine output,hemoglobin and hematocrit.Methods From June to December in 2010,there were 57 patients were suspected bleeding in abdominal cavity after operation in SICU.Recorded data including vital signs (MAP,heart rate,breathing rate,oxygen saturation),urine volume per hour,the coagulation tests (Fib,PT,aPTT,INR),TEG parameters (R,K,Angle,MA,CI),the results of blood routine (Hb,Hct,Ph) and whether bleeding or not,blood product requirements within 24 h.Results Vital signs (MAP,heart rate,breathing rate,oxygen saturation),urine output per hour and the coagulation tests (Fib,PT,INR) showed no significant correlations (P ＞ 0.05) with blood transfusion requirements,but aPTT (R =0.513,P =0.000) and MA (R =0.578,P =0.000) correlated with the blood transfusion requirement.Patients with reduced MA needed more blood transfusion requirements.Patients were divided into active bleeding group and insidious bleeding group.MA had significant difference between two groups (P =0.025),but aPTT had not.Conclusions Thrombelastography is a more accurate indicator of blood transfusion requirements,especially in active bleeding patients.