血栓弹力图在发绀型复杂先天性心脏病患儿围术期的应用价值

目的:研究发绀型复杂先天性心脏病不同红细胞压积的患儿围术期凝血功能的变化.方法:36例发绀型复杂先天性心脏病患儿分为高红细胞压积组(红细胞压积≥54%,n=20)和低红细胞压积组(红细胞压积≤54%,n=16).分别在麻醉诱导后、体外循环复温至36~C时、注射鱼精蛋白后和手术后4 h采集血样,使用血栓弹力图检测患儿凝血功能的变化.术后高红细胞压积组患儿使用纤维蛋白原和血小板治疗,低红细胞压积组使用血小板治疗,分别观察治疗后血栓弹力图指标MA、MAff、MAp的变化.①MA表明血小板和纤维蛋白原的相互作用;②MAff表明纤维蛋白原在凝血中的作用;③MAp表明血小板在凝血中的作用.结果:麻醉诱导后:高红细胞压积组比低红细胞压积组MA:(44.1±6.8)mm比(62.8±6.2)mm、MAff:(3.9±1.5)mm比(14.9±3.5)mm明显降低,差异均有统计学意义(P均<0.01).MAp:高红细胞压积组比低红细胞压积组差异无统计学意义(P>0.05).注射鱼精蛋白后:高红细胞压积组比低红细胞压积组MA:(41.7±4.0)mm比(46.7±2.9)mm、MAff:(6.0±1.9)mm比(10.1±1.7)mm明显降低,差异均有统计学意义(P均<0.01).MAp:高红细胞压积组比低红细胞压积组差异无统计学意义(P>0.05).手术后4 h:高红细胞压积组与低红细胞压积组比MA、MAff和MAp差异均无统计学意义(P均>0.05).结论:根据血栓弹力图检测的结果,高红细胞压积的复杂先天性心脏病患儿术后应该给予血小板和纤维蛋白原,而低红细胞压积的患儿只给予血小板即可达到治疗目的.

The Application Value of Thromboelastograph at Peri-Operative Period for Cyanotic Infants With Complex Congenital Heart Disease

Objective:To study the coagulation function at peri-operative period for cyanotic infants with complex congenital heart disease(CCHD)by thromboelastograph(TEG)monitored coagulation changes. Methods:A total of 36 cyanotic CCHD infants were divided into two groups according to hematocrit(HCT)value.High HCT group,n=20,the patients with HCT≥54% and Low HCT group,n=16,HCT<54%.The blood samples were collected at anesthesia induction,re-warming at 36℃ time point,after protamine injection and 4 hours after the operation.After the operation,the patient in High HCT group was treated by fibrinogen combined with platelet,Low HCT group was treated with platelet alone.TEG was applied to examine the changes of ①MA,it represents the interaction of platelet and fibrinogen;②MAff,it indicates the contribution of fibrinogen in blood coagulation;③MAp,it shows the effect of platelet in blood coagulation. Results:At anesthesia induction,the MA and MAff were both lower in High HCT group than those in Low HCT group as(44.1±6.8)mm vs.(62.8±6.2)mm and(3.9 ±1.5)mm vs.(14.9±3.5)mm,P<0.01 respectively,while Map was similar between two groups,P>0.05.After protamine injection the MA and MAff were both lower in High HCT group than those in Low HCT group as(41.7±4.0)mm vs.(46.7± 2.9)mm and(6.0±1.9)mm vs.(10.1 ±1.7)mm,P<0.01 respectively,while Map was similar between two groups,P>0.05.At 4 hours after the operation,MA,MAff and MAp were all similar between two groups,P>0.05 respectively. Conclusion:According to TEG monitoring,cyanotic CCHD infants with high HCT should be treated by fibrinogen combined with platelet after the operation,while the infants with low HCT could be treated with platelet alone.