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

doi:10.24920/J1001-9294.2017.011

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

Zhang Xue, Yu Xuerong, Huang* Yuguang. The Correlation of Indices in r-TEG with Intra-operative Blood Loss in Neurosurgical Patients[J].Chinese Medical Sciences Journal, 2017, 32(2): 69-74.

Figures/Tables 5

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References 20.

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Categories	r-TEG indices				CCT indices
Categories	ACT (sec)	K-time (min)	α-angle (degree)	MA (mm)	PT(s)	APTT(s)	INR	FBG (g/L)	PLT (×10⁹/L)
Pre-operative	112.07±10.23	1.65±0.59	70.70±6.04	59.71±6.15	11.32±0.78	28.00±13.31	0.99±0.08	2.94±0.67	238.48±54.96
Post-operative	114.54±10.71	1.79±0.67	69.69±6.04	57.12±6.04	12.54±0.89	30.71±6.09	1.12±0.09	2.11±0.72	198.92±48.18
Peri-operative changes	2.45±8.32	0.14±0.34	-0.99±2.64	-2.58±4.53	1.22±0.74	2.72±13.84	0.13±0.09	-0.83±0.63	-39.56±34.83
P value	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01

d(index)* of r-TEG	r_s	P value
ACT	0.005	0.948
K	0.095	0.203
α-angle	-0.184	0.013^**
MA	-0.104	0.164

Subgroup no.	Number of patients	d(α-angle) (degree)	Blood loss of EBV (%)
1	1	-8<dα≤-7	42.2
2	3	-7<dα≤-6	16.2±5.1
3	7	-6<dα≤-5	6.1±3.5
4	11	-5<dα≤-4	13.2±8.5
5	9	-4<dα≤-3	13.8±12.1
6	32	-3<dα≤-2	9.0±9.1
7	33	-2<dα≤-1	7.1±5.2
8	30	-1<dα≤0	7.0±4.2
9	23	0<dα≤1	6.6±3.2
10	16	1<dα≤2	6.4±3.6
11	7	2<dα≤3	5.1±2.9
12	6	3<dα≤4	11.5±7.6
13	1	4<dα≤5	0.5
14	0	5<dα≤6	-
15	1	6<dα≤7	3.8
16	1	7<dα≤8	3.7

d (index)* of CCT	r_s	P value
PT	0.076	0.307
APTT	0.093	0.212
INR	0.041	0.587
FBG	-0.180	0.015^**
PLT	-0.253	0.001^**

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