心脏手术术后血栓弹力图与凝血试验的关系及应用

Correlations between thromboelastography and coagulation tests in patients undergoing cardiac surgery

摘要:

目的  探讨心脏瓣膜手术患者术后血栓弹力图（TEG）各参数与常规凝血试验各指标的相关性，评价两种方法在心脏外科手术围手术期的应用价值。方法  选择98例择期行瓣膜手术的心脏外科手术患者，所有患者于手术结束时进行血栓弹力图（TEG）检测、常规凝血试验和血常规检测血小板（PLT）计数。分析患者TEG检测中R反应时间、K值、α角、最大振幅（MA）与凝血试验中凝血酶原时间（PT）、国际标准比值（INR）、活化部分凝血时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）及PLT之间的相关关系。结果  R时间与PT、INR、K值呈显著正相关，与α角呈显著负相关；K值与PT、INR、APTT呈显著正相关，与α、MA呈显著负相关；α角与PT、INR、APTT显著负相关，与MA显著正相关；MA与PLT显著正相关，与APTT显著负相关。心脏瓣膜手术后患者凝血功能异常主要表现为血小板数量减少，PT、INR、APTT、TT延长，FIB降低，R时间延长，MA降低。结论  心脏瓣膜手术术后TEG指标与凝血试验检测指标之间存在明显相关关系，两者对患者术后凝血功能监测都具有重要作用。心脏瓣膜手术术后患者凝血功能异常主要表现为血小板数量和功能降低，凝血因子减少，纤维蛋白原降低。

Abstract:

Objective To investigate the correlations and consistency between thromboelastography (TEG) and routine coagulation tests in patients undergoing cardiac valve surgery and to evaluate the application value of the two methods. Methods TEG, routine coagulation tests and platelet count (PLT) were performed in 98 patients after cardiac valve surgery. The correlations and consistency of R time, K value, alpha angle and maximum amplitude (MA) in TEG, and prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (FIB) in coagulation tests and PLT were tested. Results R time was positively correlated to PT, INR and K value, but negatively correlated to α angle. K value was positively correlated to PT, INR and APTT, but negatively correlated to α angle and MA. α angle was negatively correlated to PT, INR and APTT, but positively correlated to MA. MA was positively correlated to PLT, while negatively correlated to APTT. The coagulation dysfunction in the patients after cardiac valve surgery was mainly manifested as the decrease of PLT and FIB with the prolonged PT, INR, APTT, TT and R time, and the decrease of MA. Conclusions There is a significant correlation between TEG and coagulation tests in patients undergoing cardiac valve surgery, which has an important effect upon coagulation function monitoring. The coagulation dysfunction in patients after cardiac valve surgery is mainly manifested as decreased platelet number, coagulation factors and fibrinogen.