CAJ | 학술논문

目的：探讨血栓弹力图（ TEG ）在评价膝关节置换术后下肢深静脉血栓形成的价值。方法收集本组2010年3月至2013年9月行人工膝关节置换术患者116例，分别于麻醉前（T0）、手术开始后2h（T1）、术后第1天（T2）和术后第3天（T3）采集患者静脉血进行TEG检测，采用重复测量方差分析比较两组患者各采集点时TEG的R、K、α、MA、G和CI等6个参数值。结果患者在围手术期间均呈现高凝状态，且表现为进行性加重。与各指标正常值比较，膝关节置换术患者TEG指标中R和K缩短，α角、MA以及G值增大，CI增大与麻醉前T0比较，R值逐渐下降，其中T2和T3时的R下降显著；K值也成逐渐下降趋势，但不具统计学差异；α角、MA以及G值则显著性升高；CI无显著性变化。 TEG诊断对照组患者深静脉血栓的准确性为66．67％，观察组患者深静脉血栓诊断准确性为77．78％，卡方检验表明差异无统计学意义（P＞0．05）。结论 TEG是判断行膝关节置换手术患者围手术期血液高凝状态的敏感指标之一，值得临床推广。
목적：탐토혈전탄력도（ TEG ）재평개슬관절치환술후하지심정맥혈전형성적개치。방법수집본조2010년3월지2013년9월행인공슬관절치환술환자116례，분별우마취전（T0）、수술개시후2h（T1）、술후제1천（T2）화술후제3천（T3）채집환자정맥혈진행TEG검측，채용중복측량방차분석비교량조환자각채집점시TEG적R、K、α、MA、G화CI등6개삼수치。결과환자재위수술기간균정현고응상태，차표현위진행성가중。여각지표정상치비교，슬관절치환술환자TEG지표중R화K축단，α각、MA이급G치증대，CI증대여마취전T0비교，R치축점하강，기중T2화T3시적R하강현저；K치야성축점하강추세，단불구통계학차이；α각、MA이급G치칙현저성승고；CI무현저성변화。 TEG진단대조조환자심정맥혈전적준학성위66．67％，관찰조환자심정맥혈전진단준학성위77．78％，잡방검험표명차이무통계학의의（P＞0．05）。결론 TEG시판단행슬관절치환수술환자위수술기혈액고응상태적민감지표지일，치득림상추엄。
Objective To discuss the method and values of thrombelastogram ( TEG ) in the patients undergoing knee prosthesis replacement . Methods One hundred and sixteen patients who underwent knee prosthesis replacement in our hospital from March 2010 to September 2013 were collected . The venous blood of the patients were collected for thrombelastogram before anaesthesia (T0), 2 h after the operation (T1), one day (T2)and three days (T3) after the operation.The parameters of TEG including R, K,α, MA, G and coagulation composite index ( CI) were compared among these time points .Results All the patients presented hypercoagulabale state during the perioperative period and aggravated progressively .Compared with normal values , R and K values were shorten , α, MA and G values increased;CI also increased.Compared with T0, R value decreased, especially at T2 and T3; K value decreased slowly with no significant difference; αand MA signicantly increased; the difference in CI showed no statistical significance .The diagnostic accuracy of TEG for deep vein thrombosis was 66.67%in the control group while it was 77.78%in the observation group;the chi-square test showed the difference was not significant ( P >0.05 ) .Conclusion TEG could effectively determine blood hypercoagulabale state of the patients in the perioperative period and it is worthy of clinical application .