海南医学
海南醫學
해남의학
Hainan Medical Journal
2015年
21期
3173-3176
,共4页
陈冠伊%欧阳锡林%吴靖辉%王丽华
陳冠伊%歐暘錫林%吳靖輝%王麗華
진관이%구양석림%오정휘%왕려화
大量输血%血栓弹力图试验%输血管理%凝血功能
大量輸血%血栓彈力圖試驗%輸血管理%凝血功能
대량수혈%혈전탄력도시험%수혈관리%응혈공능
Massive transfusion%Thromboelastography%Blood transfution management%Blood coagulation function
目的 探讨择期手术患者术中采用血栓弹力图试验(TEG)监测止凝血功能指导输血和大剂量输血方案(MTP)输血的临床应用效果.方法 选取2011年4月至2014年6月实施择期手术并于术中大量输血(输血量>8 U红细胞/24 h)的72例患者,按输血方案不同分组,A组34例术中检测TEG指导输血,B组38例按大剂量输血方案输血.术前和术后24 h分别采集两组患者的血常规、凝血四项、出血量及异体血用血量等数据并进行比较.结果 A、B两组术后24 h内的血红蛋白(Hb)、血细胞压积(Hct)、血小板计数(Plt)、凝血酶原时间(PT)、纤维蛋白原(Fib)与术前比较均有显著性降低或延长,差异均有统计学意义(P<0.05);术后检测显示,A组Fib浓度高于B组,PT时间短于B组,差异均有统计学意义(P<0.05);两组24 h内的出血量和异体血输入量比较差异均无统计学意义(P>0.05);TEG监测发现大量输血后最大振幅(MA)低于参考值,差异有统计学意义(P<0.05).结论 两种方法指导输血,患者术后24 h内出血量和输血量基本一致,术后凝血功能较术前均有所降低,但仍在正常参考范围内,证明两种方法指导输血都可以维持患者较稳定的凝血功能,避免大出血和大量输血.
目的 探討擇期手術患者術中採用血栓彈力圖試驗(TEG)鑑測止凝血功能指導輸血和大劑量輸血方案(MTP)輸血的臨床應用效果.方法 選取2011年4月至2014年6月實施擇期手術併于術中大量輸血(輸血量>8 U紅細胞/24 h)的72例患者,按輸血方案不同分組,A組34例術中檢測TEG指導輸血,B組38例按大劑量輸血方案輸血.術前和術後24 h分彆採集兩組患者的血常規、凝血四項、齣血量及異體血用血量等數據併進行比較.結果 A、B兩組術後24 h內的血紅蛋白(Hb)、血細胞壓積(Hct)、血小闆計數(Plt)、凝血酶原時間(PT)、纖維蛋白原(Fib)與術前比較均有顯著性降低或延長,差異均有統計學意義(P<0.05);術後檢測顯示,A組Fib濃度高于B組,PT時間短于B組,差異均有統計學意義(P<0.05);兩組24 h內的齣血量和異體血輸入量比較差異均無統計學意義(P>0.05);TEG鑑測髮現大量輸血後最大振幅(MA)低于參攷值,差異有統計學意義(P<0.05).結論 兩種方法指導輸血,患者術後24 h內齣血量和輸血量基本一緻,術後凝血功能較術前均有所降低,但仍在正常參攷範圍內,證明兩種方法指導輸血都可以維持患者較穩定的凝血功能,避免大齣血和大量輸血.
목적 탐토택기수술환자술중채용혈전탄력도시험(TEG)감측지응혈공능지도수혈화대제량수혈방안(MTP)수혈적림상응용효과.방법 선취2011년4월지2014년6월실시택기수술병우술중대량수혈(수혈량>8 U홍세포/24 h)적72례환자,안수혈방안불동분조,A조34례술중검측TEG지도수혈,B조38례안대제량수혈방안수혈.술전화술후24 h분별채집량조환자적혈상규、응혈사항、출혈량급이체혈용혈량등수거병진행비교.결과 A、B량조술후24 h내적혈홍단백(Hb)、혈세포압적(Hct)、혈소판계수(Plt)、응혈매원시간(PT)、섬유단백원(Fib)여술전비교균유현저성강저혹연장,차이균유통계학의의(P<0.05);술후검측현시,A조Fib농도고우B조,PT시간단우B조,차이균유통계학의의(P<0.05);량조24 h내적출혈량화이체혈수입량비교차이균무통계학의의(P>0.05);TEG감측발현대량수혈후최대진폭(MA)저우삼고치,차이유통계학의의(P<0.05).결론 량충방법지도수혈,환자술후24 h내출혈량화수혈량기본일치,술후응혈공능교술전균유소강저,단잉재정상삼고범위내,증명량충방법지도수혈도가이유지환자교은정적응혈공능,피면대출혈화대량수혈.
Objective To study the clinical effect of two transfusion methods, blood transfusion by monitor-ing patients'coagulation state with thromboelastography (TEG) and the massive transfusion protocol (MTP), in pa-tients with elective surgical procedures. Methods Seventy-two patients with massive transfusion (>8 units of red blood cells/24 hours) were divided into two groups:the TEG group (n=34) and MTP group (n=38). Patients' data of routine blood test, coagulation test, total bleeding volume and allogeneic blood transfusion volume before and after op-eration were compared. Results Within 24 h after operation, patients' hemoglobin concentration (Hb), hematocrit (Hct), platelet count (Plt), fibrinogen (Fib), and prothrombin time (PT) were significantly decreased and prolonged (P<0.05). The postoperative fibrinogen concentrate of group TEG was higher than that of group MTP. And the postopera-tive prothrombin time of group TEG was shorter than that of group MTP. The differences were statistically significant (P<0.05). There was no statistically significant difference in the bleeding volume and allogeneic blood transfusion vol-ume between two groups (P>0.05). The maximum amplitude (MA) of TEG after massive transfusion was lower than the reference value (P<0.05). Conclusion The bleeding volume and allogeneic blood transfusion volume of both groups were similar. The postoperative coagulation function of both groups were weaker but in the normal reference range. Therefore, both of the two methods can maintain the stability of patients' coagulation function and then avoid massive bleeding or blood transfusion.
