肿瘤患者应用血栓弹力图参数指导输血治疗对围手术期临床参数的影响

Effects of thromboelastography-guided blood transfusion therapy on perioperative clinical parameters in tumor patients

摘要:

目的 探讨肿瘤患者使用血栓弹力图（TEG）参数指导输血治疗对围手术期临床参数的影响。方法 选取2019年1月—2024年1月中国人民解放军联勤保障部队第九〇三医院138例需进行手术治疗的肿瘤患者。通过随机数字表法分为治疗组和对照组，每组69例。治疗组通过使用TEG技术监测患者的血液凝固状态，根据TEG参数定制化输血方案。对照组患者接受常规输血治疗。比较两组血液制品的使用量，凝血功能指标、血常规指标、TEG参数，术后出血量及住院天数。结果 治疗组新鲜冰冻血浆、悬浮红细胞、冷沉淀凝血因子和血小板使用量均少于对照组（P <0.05）。治疗组凝血时间、活化部分凝血活酶时间均短于对照组（P <0.05），纤维蛋白原低于对照组（P <0.05），凝血酶时间长于对照组（P <0.05）。治疗组治疗前后红细胞压积、血小板计数、血红蛋白的差值均高于对照组（P <0.05）。治疗组形成速率、30 min后的纤维蛋白溶解指标、血块最大振幅均高于对照组（P <0.05），凝固形成时间、凝血反应时间均短于对照组（P <0.05）。治疗组术后出血量少于对照组，住院时间短于对照组（P <0.05）。结论 肿瘤患者在围手术期应用TEG参数指导输血治疗可以有效优化血液制品的使用，并改善凝血功能及临床恢复指标。

Abstract:

Objective To explore the effects of thromboelastography (TEG)-guided blood transfusion therapy on perioperative clinical parameters in tumor patients.Methods A total of 138 tumor patients requiring surgical treatment at the 903 Hospital of the Joint Logistics Support Force of the People's Liberation Army of China from January 2019 to January 2024 were recruited. Participants were divided into a treatment group and a control group via the random number table method, with 69 cases in each group. The patients in the treatment group were monitors for the blood coagulation status using TEG, based on which personalized transfusion strategies were adopted. In contrast, the patients in the control group were managed according to standard transfusion practices. The usage of blood products, coagulation function indicators, blood routine indicators, TEG parameters, postoperative blood loss, and length of hospital stays were compared between the two groups.Results The treatment group used fewer fresh frozen plasma, suspended red blood cells, cryoprecipitated antihemophilic factors, and platelets compared to the control group (P < 0.05). The prothrombin time and the activated partial thromboplastin time were shorter and the level of fibrinogen was lower in the treatment group compared with the control group (P < 0.05), while the thrombin time in the treatment group was longer than that in the control group (P < 0.05). The differences in the hematocrit, platelet count, and hemoglobin levels before and after treatment were higher in the treatment group than in the control group (P < 0.05). The alpha-angle, lysis at 30 minutes, and maximum amplitude in the treatment group were greater than those in the control group (P < 0.05), whereas the K time and reaction time in the treatment group were shorter than those in the control group (P < 0.05). The treatment group had less postoperative blood loss and shorter length of hospital stays compared with the control group (P < 0.05).Conclusions In tumor patients, the application of TEG-guided transfusion strategies during the perioperative period significantly optimizes the use of blood products and improves coagulation profiles and clinical recovery indicators.