CAJ | 학술논문

目的应用血栓弹力图（thromboelastogram，TEG）监测门静脉高压症（portal hypertension，PHT）患者行脾切除术中应用血液回输期间凝血功能的变化规律。方法对13例 PHT 患者进行术前、术后常规凝血功能指标及TEG 测定。术前发现异常者予以相应的血液制品及治疗。常规凝血功能指标包括血小板计数（PLT）、血浆凝血酶原时间（PT）、活化的部分凝血活酶时间（APTT）、TEG 参数包括反应时间 R 值、K 值、α角及最大振幅 MA。对手术前后的检查结果进行比较。结果患者术前术后 PT、APTT 明显缩短，PLT 明显增加，TEG 参数中 R 值明显缩短、K 值下降、α角增大、MA 没有显著变化，患者凝血状态较术前明显改善。结论TEG 对判断 PHT 患者脾切除术中行血液回输时的凝血功能变化有重要意义，可指导围手术期的血液保护。
목적응용혈전탄력도（thromboelastogram，TEG）감측문정맥고압증（portal hypertension，PHT）환자행비절제술중응용혈액회수기간응혈공능적변화규률。방법대13례 PHT 환자진행술전、술후상규응혈공능지표급TEG 측정。술전발현이상자여이상응적혈액제품급치료。상규응혈공능지표포괄혈소판계수（PLT）、혈장응혈매원시간（PT）、활화적부분응혈활매시간（APTT）、TEG 삼수포괄반응시간 R 치、K 치、α각급최대진폭 MA。대수술전후적검사결과진행비교。결과환자술전술후 PT、APTT 명현축단，PLT 명현증가，TEG 삼수중 R 치명현축단、K 치하강、α각증대、MA 몰유현저변화，환자응혈상태교술전명현개선。결론TEG 대판단 PHT 환자비절제술중행혈액회수시적응혈공능변화유중요의의，가지도위수술기적혈액보호。
Objective To assess the role of thromboelastography (TEG)in monitoring coagulation changes of autologous transfusion during splenectomy for portal hypertension (PHT)and its significance for blood protection. Methods Routine coagulation tests and TEG were completed during the surgeries.Blood products were used and relevant treatments were undertaken when abnormal results were found preoperatively.Routine coagulation tests included platelet count (PLT),prothrombin time (PT)and activated partial thromboplastin time (APTT).TEG indexes included reaction time (R),K value,α angle and maximum amplitude (MA).Then conventional coagulation indexes were compared with TEG indexes respectively.Results Thirteen PHT patients undergoing splenectomy and receiving autotransfusion were enrolled.Compared with preoperative,PT and APTT were significantly decreased,PLT was significantly increased,while reaction time and K value were significantly decreased,α angle was increased,and MA remained unchanged in the postoperative period.Conclusions TEG can be a monitor of coagulation preoperatively and a guidance for blood protection in autotransfusion during splenectomy for PHT.