摘要
目的探讨血栓弹力图(TEG)在指导围术期出血量大于1000 mL非小细胞肺癌患者的非红细胞输血应用效果和价值。方法随机选取2016年2月至2020年8月,于汕头市中心医院和中山大学附属第一医院就诊,围术期前预计出血量1000 mL以上的171例非小细胞肺癌患者为TEG指导组,采用TEG检测作为选择输血治疗的参考依据。另以同期围术期前预计出血量1000 mL以上的105例非小细胞肺癌患者为常规指导组,采用血常规凝血检测作为选择输血治疗的参考依据。比较两组患者术中新鲜冰冻血浆(FFP)、冷沉淀(CRYO)、血小板(PLT)使用量的差异,进一步比较两组患者术中出血量、术后24 h出血量、术后住院时间、术后二次出血率、术后15 d和60 d病死率的差异。结果围术期出血量1000 mL以上接受成分输血的非小细胞肺癌患者,TEG异常凝血功能图形表现为低凝状态图形及原发性纤溶亢进图形。TEG指导组的非小细胞肺癌患者术中FFP、CRYO、PLT用量均少于常规指导组,两组指标相比较,差异均有统计学意义(均P<0.05)。TEG指导组术中出血量、术后24 h出血量均少于常规指导组,术后二次出血率、术后住院时间、术后15 d和60 d病死率均低于常规指导组,但两组术中出血量、术后24 h出血量、术后二次出血率相比较,差异无统计学意义(P>0.05),而两组的术后住院时间、术后15 d和60 d病死率,差异均有统计学意义(均P<0.05)。结论针对围术期出血量1000 mL以上非小细胞肺癌患者的围术期大输血治疗,TEG可有效指导选择血液制品的类型,合理调整输注剂量,能有效降低术后15 d和60 d的病死率,提高输血治疗的质量和安全性。
Objective To investigate the application effect and value of thromboelastography(TEG)in guiding non red blood cell transfusion in patients with non-small cell lung cancer whose blood loss was more than 1000 mL.Methods From February 2016 to August 2020,171 patients with non-small cell lung cancer(NSCLC)who were treated in Shantou Central Hospital and the First Affiliated Hospital of Sun Yat-sen University and had an estimated blood loss of more than 1000 mL before operation were randomly selected as the TEG guidance group,and the TEG test was used as the reference basis for the selection of blood transfusion treatment.In addition,105 patients with non-small cell lung cancer who predicted the bleeding volume of 1000 mL before the same period were used as the routine guidance group,and blood coagulation test was used as the reference for blood transfusion treatment.The differences of intraoperative fresh frozen plasma(FFP),cryoprecipitate(cryo)and platelet(PLT)usage were compared between the two groups,and the differences of intraoperative blood loss,postoperative 24 h blood loss,postoperative hospital stay,postoperative secondary bleeding rate,postoperative 15 day and 60 day mortality were further compared between the two groups.Results In patients with non-small cell lung cancer whose perioperative blood loss was more than 1000 mL,the abnormal coagulation function of TEG showed the pattern of low coagulation state and primary hyperfibrinolysis.The dosage of FFP,cryo and PLT in TEG guidance group was less than that in conventional guidance group,and the differences were statistically significant(all P<0.05).The intraoperative blood loss,postoperative 24 h blood loss in TEG group were less than those in conventional guid ance group,postoperative secondary blood loss rate,postoperative hospital stay,postoperative 15 day and 60 day mortality in TEG group were lower than those in conventional group,however there was no significant difference on intraoperative blood loss,postoperative 24 h blood loss and postoperative secondary bleeding rate between the two groups(P>0.05),but there were significant differences on postoperative hospital stay,postoperative 15 day and 60 day mortality between the two groups(all P<0.05).Conclusion TEG can effectively guide the selection of blood products,reasonably adjust the infusion dose,effectively reduce the mortality of 15 and 60 days after operation,and improve the quality and safety of blood transfusion.
作者
洪小慈
李行勇
张式鸿
郑晓和
林祥伟
李海彬
HONG Xiaoci;LI Xingyong;ZHANG Shihong;ZHENG Xiaohe;LIN Xiangwei;LI Haibin(Department of Blood Transfusion,Shantou Central Hospital,Shantou,Guangdong 515031,China;Department of Clinical Laboratory,Shantou Central Hospital,Shantou,Guangdong 515031,China;Department of Clinical Laboratory,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong 510080,China)
出处
《国际检验医学杂志》
CAS
2021年第14期1705-1709,共5页
International Journal of Laboratory Medicine
基金
广东省医学科学技术研究基金项目(A2017177)
广东省汕头市科技计划医疗卫生类别项目[汕府科(2017)119号-18]。
关键词
血栓弹力图
常规凝血检测
围术期
输血
thrombelastography
routine coagulation test
perioperative period
blood transfusion
作者简介
洪小慈,女,主管技师,主要从事输血学技术方面的研究;通信作者:李海彬,E-mail:3407213508@qq.com。
