血栓弹力图指导老年腰椎结核患者术中输血的临床研究

目的 探讨血栓弹力图（Thrombelastography，TEG）指导老年腰椎结核手术患者术中输血的临床应用价值。 方法 选取2019年1月至2021年12月在浙江大学医学院附属杭州市胸科医院接受腰椎结核后路椎弓根螺钉内固定联合前路病灶清除植骨融合术的老年患者80例，随机分为试验组和对照组。术中两组均根据血气分析结果中的血红蛋白（Hemoglobin,Hb）决定是否输注悬浮红细胞（Suspended Red Blood Cells,SRBC）。试验组在TEG结果指导下输注新鲜冰冻血浆（Fresh Frozen Plasma，FFP），对照组则根据临床经验决定输注新鲜冰冻血浆。记录术中失血量、术中SRBC与FFP的输注量、术中输液量、尿量、术后引流量、术后住院时间、术前1天和术后1天的血常规及常规凝血功能检测指标等。 结果 试验组的术中失血量、SRBC和FFP的输注量均低于对照组，差异有统计学意义（P<0.05）；试验组术后引流量及术后住院时间均少于对照组，差异有统计学意义（P<0.05）；试验组的活化部分凝血活酶时间（Activated Partial Thromboplastin Time，APTT）短于对照组、纤维蛋白原（Fibrin，FIB）含量高于对照组，差异有统计学意义（P<0.05）；两组的Hb、血小板计数（Platelet，PLT）、凝血酶原时间（Prothrombin Time ,PT）及FIB含量术前、术后比较差异有统计学意义（P<0.05）。结论 用TEG指导老年腰椎结核手术患者术中输血可以减少成分输血量并减少出血及术后住院时间。

Clinical study of thrombelastography guiding blood transfusion in elderly patients with lumbar tuberculosis

Objective To investigate the clinical application value of thrombelastography (TEG) in guiding intraoperative blood transfusion in elderly patients with lumbar tuberculosis surgery. Methods A total of 80 elderly patients with lumbar tuberculosis undergoing one-stage combined anterior-posterior surgery were selected from January 2019 to December 2021 in Hangzhou Red Cross Hospital.The patients were randomly divided into experimental and control groups. Both groups determined the infusion of suspended red blood cells (SRBC) according to the concentration of hemoglobin (Hb) in the blood gas analysis results. The experimental group was transfused with fresh frozen plasma guided by the TEG results. The control group decided to transfuse fresh frozen plasma according to clinical experience. The intraoperative blood loss, intraoperative transfusion volume of suspended red blood cells and fresh frozen plasma (FFP), intraoperative transfusion volume, urine volume, postoperative drainage volume, postoperative hospital stay, blood routine test and coagulation function test indexes were recorded. Results The intraoperative blood loss, SRBC, and FFP infusion volume in experimental group were all lower than those in the control group, and the differences were statistically significant (P <0.05).The postoperative drainage volume and postoperative hospital stay of the experimental group were less than those of the control group(P <0.05). The APTT of the experimental group was shorter than that of the control group, the concentration of fibrinogen (FIB) was higher than that of the control group, and the differences were statistically significant (P<0.05).There were differences in Hb, platelet (PLT), prothrombin time (PT) and FIB concentration between the two groups before and after operation (P<0.05). Conclusion Using TEG to guide intraoperative blood transfusion in elderly patients with lumbar tuberculosis can reduce the amount of blood component transfusion and reduce bleeding and postoperative hospital stay.