肝素酶纠正的血栓弹力图在胸心外科患者术后的应用

DOI10．13602/j．cnki．jcls．2014．11．07··*赵凌张敏徐智杰李莺周小玉南京医科大学第一附属医院输血科南京210029评价肝素酶纠正的血栓弹力图hmTEG在胸心外科患者术后的应用价值。选择268例胸心外科患者在胸心外科手术后检测普通TEG和hmTEG两组结果分别进行配对t检验。其中31例患者同时检测了活化凝血时间ACT将ACT值与hmTEG各参数进行相关性分析。普通TEG和hmTEG各参数比较最大振幅MA差异未见统计学意义P＞0．05Ｒ、K、Angle和CI凝血综合指数差异均有统计学意义P＜0．05。ACT与K、△Ｒ呈正相关r分别为0．500、0．536P＜0．05ACT与Angle、MA、CI呈负相关r分别为－0．383、－0．323、－0．334P＜0．05ACT与Ｒ不相关。hmTEG在监测胸心外科患者术后的凝血功能及判断肝素残留方面具有一定价值。胸心外科血栓弹力图肝素酶纠正活化凝血时间肝素残留Ｒ446AApplicationofheparinase-modifiedthromboelastographyinpostoperativepatientsofcardiothoracicsurgeryZHAOLingZhangMinXUZhi-jieLIYingZHOUXiao-yuDepartmentofBloodTransfusiontheFirstAffiliatedHospitalofNan-jingMedicalUniversityNanjing210029ChinaAbstractObjectiveToevaluatetheclinicalapplicationofheparinase-modifiedthromboelastographyhmTEGinthepostoperativepatientsofcardiothoracicsurgery．MethodsAtotalof268patientsundergoingthoracicsurgerywereincludedinourstudyinwhichTEGandhmTEGweresimultaneouslyassayedforthepatientsafteroperation．Thesignificancesofthebothtestswereanalyzedwithpairedt-test．TheactivatingclottingtimeACTwastestedin31patientsafteroperation．ThecorrelationbetweenthevaluesofACTandhmTEGwasanalyzed．ＲesultsComparingtheresultsofTEGwiththoseofhmTEGthevaluesofＲKangleandclottingindexCIexhibitedsignificantlystatisticaldifferenceP＜0．05exceptforMAvalueP＞0．05．ThevaluesofACTshowedsignificantlypositivecorrelationwiththevaluesofKand△Ｒandthecorrelationcoefficientswere0．500and0．536respectivelyP＜0．05．ThenegativecorrelationsofthevaluesofACTwithangleMAandCIwerefoundandthecorrelationcoefficientswere－0．383－0．323and－0．334respectivelyP＜0．05．NocorrelationbetweenthevaluesofACTandＲwasshownandthecorrelationcoefficientwas0．138．ConclusionHeparinase-modifiedthromboelastographyhmTEGshouldbemorevaluableinmonitoringthebloodcoagulationfunctionandassessingtheheparinresiduesinthepostoperativepatientswiththoracicsurgery．Keywordscardiothoracicsurgeryheparinase-modifiedthromboelastographyactivatingclottingtimeheparinresiduesⅢ1。CABG、lowmolecularweightheparinLMWH2。。。prothrombintimePT、ac-tivatedpartialthromboplastintimeAPTT、plateletPLT、fibrinogenFibactivatedclottingtimeACT。3。。、。thromboelastog-raphyTEG4。hmTEG·528·2014113211ChinJClinLabSciNov．2014Vol．32No．11*201303037。1983。[e-mail]。TEG。TEG。hmTEG。11．12011920143268TEGhmTEG1641041～8357．5。TEGACTTEG。1．2Thrombelelastograph-5000ITCHemochronJr．Signature、。1．3TEG2mL0．109mol/L91、。1mL2IU6IU20μL340μLTEG2h。TEGＲ、K、Angle、maximumamplitudeMA、LY30、coagulationindexCI。Ｒ5～10minKTEG20mm1～3minAngleTEG53°～72°MA50～70mmLY30MA30min0～8%coagulationin-dexCI－3～+3。TEGＲ＞Ｒ△Ｒ。1．4ACT1mL1～2。ACT90～130s。ACT＞130s。1．5SPSS16．0。±珋x±st。ACThmTEGPearsonP＜0．05。22．1TEGhmTEG1。26810616260%。15Ｒ＞2Ｒ。253TEGＲ、K、Angle、MA、CIP＞0．05。tMAP＞0．05Ｒ、K、Angle、CIP＜0．05。1、TEGn=253珋x±sＲminKminAngle°MAmmCI8．32±4．294．67±3．6045．46±13．6449．41±9．59－5．42±5．506．78±1．823．80±1．8348．29±11．3349．18±8．94－3．92±3．13tP7．50＜0．054．51＜0．05－4．98＜0．050．633＞0．05－5．84＜0．052．2hmTEGACT16231ACThmTEGACT2。ACThmTEGACTK、△Ｒr0．500、0．536P＜0．05ACTAngle、MA、CIr·628·2014113211ChinJClinLabSciNov．2014Vol．32No．11－0．383、－0．323、－0．334P＜0．05ACTＲ。2hmTEGACTn=31珋x±sＲmin9．2±2．83．8～15．1Kmin5．4±3．72．2～17．4Angle°40．6±12．815．6～61．3MAmm46．9±12．321．7～71．0CI－7．6±5．7－25．6～－3．0△Ｒmin21．3±22．8－1．0～80．6ACTs145．6±43．3105．0～289．03ACTACT480sACT5。。TEGTEG24hTEG。26816260．4%Ｒ、K、AngleCIhmTEGTEG6。TEGhmTEGMAPLT、、、、-7。TEG31ACTACThmTEGKFibACT8。△ＲACThmTEGACT。4ACTTEG。2ACTTEG2。4TEGACT。。41．J．2012298644-649．2．J．20097440-44．3．J．201199170．4ＲeikvamHSteienEHaugeBetal．ThrombelastographyJ．TransfusApherSci2009402119-1235．PCIJ．201232111486-1489．6．-ＲJ．2013194169-171．7．J．2008101113-117．8SolomonCPichlmaierUSchoechlHetal．ＲecoveryoffibrinogenafteradministrationoffibrinogenconcentratetopatientswithseverebleedingaftercardiopulmonarybypasssurgeryJ．BrJAnaesth20101045555-562．2014-06-24王海燕陈维忠·728·2014113211ChinJClinLabSciNov．2014Vol．32No．11