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| 血栓弹力图在肝炎肝硬化患者术中评价凝血功能的应用 |
| Application of thromboelastography for patients with liver cirrhosis under liver resection |
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| DOI：10.12089/jca.2017.12.1181 |
| 中文关键词: 血栓弹力图 凝血功能 乙型肝炎肝硬化 肝脏部分切除术 |
| 英文关键词: Thromboelastography Coagulation function Liver cirrhosis Liver resection |
| 基金项目:2015年第四期江苏省“333工程”培养资金资助项目 |
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| 中文摘要: |
目的 探讨血栓弹力图(TEG)用于乙型肝炎肝硬化患者围术期指导成份输血的临床意义。
方法 2015年4月5日至2016年10月30日择期在全麻下行肝脏部分切除术的乙型肝炎肝硬化患者60例, 男46例, 女14例, 年龄35～65岁, ASA Ⅱ或Ⅲ级, Child-Pugh分级为B或C级, 采用计算机随机数字表法, 将患者随机分为两组, TEG组和对照组, 每组30例。TEG组主要观察并测量凝血反应时间(R值)、形成时间(K值)、血栓最大幅度(Ma值)和凝固角(α值), 并结合血气分析结果决定输注血液制品的种类和数量。对照组则根据凝血功能常规检测、血气分析结果及出血量的情况, 选择输注血液制品的种类和数量。
结果 TEG组的出血量以及血液制品输注量(包括悬浮红细胞、新鲜冰冻血浆、冷沉淀、血小板)均明显少于对照组(P<0.05); TEG组术后12、24 h的引流量明显少于对照组(P<0.05)。
结论 TEG可实时监控患者凝血功能的变化,指导围术期合理地输注血液制品, 从而减少手术中血液制品的输入量, 减少术后腹腔出血几率, 在乙型肝炎肝硬化患者肝脏部分切除术中具有一定的应用价值。 |
| 英文摘要: |
Objective To investigate the effect of thromboelastography (TEG) in guiding clinical transfusion in liver cirrhosis patients during operation.
Methods Sixty liver cirrhosis patients who underwent liver resection under general anesthesia from April 5, 2015 to October 30, 2016 were selected in this study. Among them, there were male in 46 cases and female in 14 cases, ASA physical status Ⅱ or Ⅲ, Child-Pugh grade B or C. According to coagulation function, the patients were divided into thrombelastogram analysis group (group TEG, n=30) and empirical treatment group (group control, n=30). The coagulation time (R), the formation time (K), the maximum amplitude of thrombosis (Ma) and solidification angle (alpha value) were observed and recorded. According to the analysis results, choice type and quantity of infused blood was chosen.
Results The bleeding volume in group TEG and blood transfusion (including suspended red blood cells, fresh frozen plasma, cryoprecipitate, platelet) were significantly reduced, compared with the group control (P<0.05); the bleeding volume of 12, 24 h in group TEG was significantly lower than that in group control (P<0.05).
Conclusion Thromboelastography can monitor the real-time blood coagulation function in patients, guide the perioperative blood transfusion and reduce the input of blood products during the surgery and postoperative abdominal bleeding occurrence, which has important application value in resection of liver cirrhosis in patients with liver cancer. |
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