Chinese Medical Sciences Journal ›› 2017, Vol. 32 ›› Issue (2): 69-74.doi: 10.24920/J1001-9294.2017.011

• •    下一篇

神经外科手术病人快速血栓弹力图指标与术中出血量关系

张雪, 虞雪融, 黄宇光*()   

  1. 麻醉科,北京协和医院,中国医学科学院北京协和医学院,北京,100730,中国
  • 收稿日期:2016-08-07 出版日期:2017-06-20 发布日期:2017-06-10
  • 通讯作者: 黄宇光 E-mail:garybeijing@163.com

The Correlation of Indices in r-TEG with Intra-operative Blood Loss in Neurosurgical Patients

Zhang Xue, Yu Xuerong, Huang* Yuguang()   

  1. Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2016-08-07 Online:2017-06-20 Published:2017-06-10

摘要:

目的 术中凝血功能障碍与出血量及患者预后密切相关。快速血栓弹力图是一种评估术中凝血功能异常及指导血液制品输注的有效方法。本研究旨在探索快速血栓弹力图指标与出血量的关系。方法 本研究纳入了北京协和医院2013年1月15日至4月30日期间行经鼻蝶鞍区占位切除术或开颅手术的患者。所有患者均行术前术后快速血栓弹力图及传统凝血功能检查,并对患者的基本信息及术中出血量(以出血量占估计总体血容量百分比表示)进行记录。我们用Spearman相关性分析法来分析快速血栓弹力图及传统凝血功能检查各指标与术中出血量的关系,并对快速血栓弹力图指标中与术中出血量显著相关的指标进行进一步线性回归分析。结果 181例符合纳入标准的患者入选本研究。反应患者纤维蛋白原水平的α角的术中变化是唯一与出血量显著相关的快速血栓弹力图指标(P=0.013, r= -0.184)。这个结果对出血影响凝血功能的经验性认识提出了挑战。我们发现,随着术中出血量的增加,α角逐渐减小;约每1%术中出血会导致α角减小约0.6°。对传统凝血功能检查结果的分析显示,纤维蛋白原(P=0.015)和血小板数量同样与术中出血量显著相关(P=0.001)。结论 围手术期快速血栓弹力图α角的变化与术中出血量显著相关,术中出血对纤维蛋白原水平的影响应该受到更多重视。

关键词: 输血管理, 快速血栓弹力图, 术中出血, 神经外科手术

Abstract:

Objective Intra-operative coagulopathy has a close relationship with blood loss and the prognosis of patients. Rapid-thrombelastography (r-TEG) is a comprehensive assessment of coagulation abnormalities and also an effective way for constructing blood transfusion. This study attempts to investigate the correlation of r-TEG indices with intra-operative hemorrhage.Methods Patients who underwent transphenoidal hypophysectomy and craniotomy from January 15 to April 30, 2013 in Peking Union Medical College hospital were recruited. All patients had pre- and post-operative r-TEG and conventional coagulation tests (CCTs). Patients’ information and intra-operative blood loss as a percentage of estimated blood volume were recorded. Spearman’s correlation analyses were used for discovering the relationship between indices in r-TEG or CCTs and the intra-operative blood loss. The significant correlated index of r-TEG was further investigated using linear regression analysis. Results A total of 181 patients participated in this study. Intra-operative change of α-angle, which reflects the fibrinogen level and function, was the only r-TEG index that correlated with blood loss significantly (P=0.013, r= -0.184), thus challenging the current empirical cognition of the effects of intra-operative hemorrhage on coagulation. As intra-operative blood loss increased, α-angle decreased, and every 1% loss of estimated blood volume (EBV) led to 0.60 degree decrease of α-angle. As for CCT results, changes of fibrinogen and platelet count were also significantly correlated with blood loss (P=0.015 and P=0.001, respectively).Conclusions Peri-operative change of α-angle, as an index of r-TEG, exhibited a significant negative correlation with intra-operative blood loss. The impact of hemorrhage on fibrinogen, instead of clotting factors, should be scrutinized.

Key words: blood transfusion management, rapid-thrombelastography, intra-operative blood loss, neurosurgery

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