血栓弹力图在体外循环心血管手术的应用

摘要

OBJECTIVE To analyze the usefulness of thromboelastography ( TEG ) in cardiovascular surgery. METHODS 309 patients underwent cardiac and aortic surgery with cardiopulmonary bypass who received TEC measurement perioperatively were analyzed retrospectively. There were 105 patients who received both pre - and postoperative TEG measurement. 31 TEG tests were taken preoperatively only, 37 TEG tests taken during and postoperatively, and 136 TEG tests taken postoperatively only. Total 451 TEG tests ( there were 136 tests performed preoperatively, 37 tests during operation, and 278 tests taken postoperatively ) were accomplished. All TEG results, excessive hlood loss after cardiac surgery , surgical re - exploration for bleeding, and platelet count were recorded. RESULTS There were twelve patients ( 8. 8％ ) preoperatively with abnormal TEG results mainly because of low fibrinogen.Seventeen Patients, out of thirty - seven ( 45. 9％ ), had abnormal TEG during surgery, including platelet dysfunction ( 35. 1％ ), low fibrinogen ( 18. 9％ ), low clotting factors ( 8. 1％ ) and residual heparin ( 5. 4％ ). Ninety - five patients ( 34. 1％ ) suffered from abnormal TEG postoperatively, including platelet dysfunction ( 25. 9％ ) , heparin residual ( 18. 3％ ). low fibrinogen ( 14. 8％ ) and low clotting factors ( 6. 1％ ). Platelet function was significant decreased postoperatively compare to baseline ( P ＜0. 001 ). There were twenty - eight patients ( 9. 1％) suffering from excessive bleeding after cardiac surgery with cardiopulmonary bypass, among them eight patients had normal TEG results and dictated re - exploration for bleeding. The cause for bleeding was surgical in six of the eight patients, and other two patients had an inappropriate surgical intervention for bleeding. The sensitivity of TEG for surgical bleeding was 75％ . Twenty patients, out of twenty - eight excessive bleeding patients, had moderate to severe abnormal TEG results , seventeen patients were getting better after appropriate treatment, and three patients underwent re - exploration for bleeding and surgical bleeding were confirmed. The specificity was 85％. CONCLUSION This retrospective study showed that TEG test is helpful for diagnosing and curing excessive bleeding patients after cardiac surgery with cardiopulmonary bypass.%目的 评价血栓弹力图(TEG)在体外循环心血管手术的应用价值.方法 回顾分析309例体外循环心血管手术围术期进行TEG检查的病例,其中105例在手术前、后均行TEG检查,31例仅在术前、37例在术中和术后、136例仅在术后行TEG检查,共451例(术前136例、术中37例、术后278例).结果 术前,有8.8%(12/136)患者存在TEG异常,主要是纤维蛋白原缺乏;术中,有45.9% (17/37)TEG发生异常,包括血小板功能减低(35.1%)、纤维蛋白原缺乏(18.9%),凝血因子缺乏(8.1%)、肝素残留(5.4 %);术后,有34.1%(95/278)发生TEG异常,原因分别为血小板功能减低(25.9%)、肝素残留(18.3%)、纤维蛋白原缺乏(14.8%)、凝血因子缺乏(6.1%).与术前比较,术后患者表现为低凝,尤其是血小板功能显著降低,P<0.001.28例患者发生术后异常出血,其中8例TEG正常,提示存在活动出血,二次开胸手术发现6例有活动出血,其敏感性为75%;20例TEG显著异常,17例经对症治疗后出血显著减少,3例治疗无效,经开胸手术发现存在活动出血,其特异性为85%.结论 TEG有助于心血管手术后患者异常出血的诊断和治疗.