血栓弹力图报告非医疗原则前提下的修正

<正>美国Haemoscope公司生产的血栓弹力图仪(Thrombelastography,TEG),是一种从整个动态过程来监测凝血过程的分析仪。与常规凝血检测方法相比,TEG更加快捷、精确,是整体评价凝血功能的一个敏感实验。TEG自1948年由德国人Harter发明以来,其在指导术中输血及围手术期监测凝血功能方面体现出越来越重要的价值,同时在指导临床科学合理用血,节约血液资源方面发挥着     

血栓弹力图及凝血试验用于心脏瓣膜术后检测的价值及两者相关性分析

目的:探讨血栓弹力图(TEG)及凝血试验在用于心脏瓣膜手术后检测的价值,分析TEG及凝血试验的相关性。方法:回顾分析100例2014年3月至2017年5月,在本院进行心脏瓣膜手术的成人患者,患者均于手术结束时进行了TEG检测和凝血试验、血常规检测PLT。分析患者TEG检测中各参数与凝血试验各指标之间的相关性,探讨二者对心脏瓣膜术后检测的价值。分析心脏瓣膜手术后患者的TEG检测中K值、R值(反应时间)、α角、MA(最大振幅)与凝血试验中的参数PT(凝血酶原时间)、INR(国际标准比值)、APTT(活化部分凝血时间)、TT(凝血酶时间)、FIB(纤维蛋白原)及PLT这些参数之间的相关性关系。结果:K值与PT、R值、 INR、APTT呈显著正相关;R值与K值、 INR、PT、APTT呈显著正相关;α角与PT、INR、APTT、K值、R值呈负相关,与MA显著正相关;MA与PLT显著正相关,与APTT显著负相关。结论:TEG指标和凝血试验对心脏瓣膜术后患者的的凝血功能监测都具有重要的作用,二者之间具有明显相关关系。心脏瓣膜置换术后患者应用TEG和凝血试验进行监测对指导临床输血具有积极意义,两者结合能够快速判断出血的原因,减少手术后的并发症和出血量,还能避免过度治疗、指导血液制品的合理使用。     

原位肝移植围手术期凝血功能分析95例

目的:探讨原位肝移植围手术期凝血功能的变化规律以及各凝血指标对于原位肝移植围手术期凝血功能测定的敏感性.方法:2004-01/2006-11于我院行同种异体肝移植术患者95例.分别测定肝移植术前、术中(无肝前期、无肝期及新肝期)及术后24、72h的凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(Fib)、血小板计数(PLT),并描记Sonoclot曲线.用SPSS10.0进行自身配对样本T检验统计学分析.结果:随肝移植手术进行,凝血功能逐渐恶化:PT、APTT逐渐延长,PLT、Fib逐渐减少.至新肝期逐渐达到高峰,以后除PLT外均逐渐好转,术后72 h基本恢复至术前水平.Sonoclot曲线体现:激活全血凝固时间(ACT)逐渐延长,凝结速率(CR)逐渐下降,新肝期为最显著,之后逐渐好转.围手术期血小板功能(PF)无明显差异( P>0.05).结论:Sonoclot凝血及血小板功能分析仪的应用对于肝移植术中凝血功能变化的监测及对症处理具有非常重要的作用.     

血栓弹力图在心脏外科的发展及应用

血栓弹力图(Thromboelastography,TEG)是一种能够连贯性反映凝血及纤溶全过程的凝血监测图像,较之传统检测方法,TEG能自血液凝固开始到血小板交联形成、纤维蛋白产生、血凝块发生与发展、血块形成达到最大值和血凝块自降解开始直至溶解等等一系列变化进行描述。目前心脏外科手术治疗过程中,TEG已成为一项重要的辅助检查,在各种不同术式及围术期成分输血等过程中具有很大指导意义。本文回顾文献,介绍TEG在心脏外科的发展和应用。     

TEG及传统凝血检测指标在孕妇血液不同稀释状态下的相关性探讨

血栓弹力图(thromboelastography,TEG)最早是由德国的Harler E于1948年提出的,是一种动态监测和分析全血标本的整体凝血状况的体外诊断仪器,可以综合反映患者凝血指标的变化[1].随着技术的发展,TEG开始广泛应用于临床,成为检测凝血功能的重要指标.近年来,麻醉、创伤、重症、产科、外科围手术及...     

血栓弹力图预测老年重症患者血栓发生的敏感度及特异度

目的探讨血栓弹力图(TEG)预测老年重症患者血栓发生的敏感度与特异度的临床应用价值。方法选取该院重症监护室(ICU)于2015年10月至2016年12月收治的200例重症患者进行回顾性分析,均接受TEG、常规凝血功能指标检测及血小板计数(PLT)检查,对TEG参数、凝血4项指标、PLT所得结果进行相关性分析,并对TEG、常规凝血功能指标预测敏感度、特异度进行评价。结果 TEG参数凝血反应时间(R)与凝血酶原时间(PT)无相关性,与活化部分凝血活酶时间(APTT)呈正相关,TEG参数凝血形成时间(K)与纤维蛋白原(Fib)、PLT呈负相关,TEG参数最大凝块强度(MA)与Fib、PLT呈正相关,TEG参数凝固角(Angle)与Fib、PLT呈正相关(均P<0.05);TEG参数R、K、MA、Angle与D-二聚体(D-dimer)均无相关性(P>0.05);TEG参数R与K呈正相关,MA、Angle与K均呈负相关,MA与R呈负相关,MA与Angle呈正相关,Angle与R呈负相关(均P<0.05);TEG、常规凝血功能指标预测血栓敏感度均<50.0%,但TEG参数预测特异度高于常规凝血功能指标。结论 TEG预测老年重症患者血栓发生的敏感度较低,特异度较高,能降低血栓发生误诊风险,具有一定指导意义,且与常规凝血功能指标无法相互替代,实际应用需与临床、实验室检测结合进行综合考虑。     

肝移植患者围手术期成分输血分析与评估

目的:分析127例肝移植患者在围手术期的成分输血情况,为肝移植术围手术期科学、安全、合理输血提供依据。方法:以回顾性研究方法观察127例肝移植患者成分输血情况及部分患者术后血栓弹力图检测(TEG)结果,分析术前、术中和术后各期悬浮红细胞、新鲜冰冻血浆、血小板、冷沉淀的输注情况。结果:127例肝移植患者围手术期人均输血5 011.5ml,术前占0.5%,术中占76.3%,术后占23.2%;术前、术中、术后悬浮红细胞与新鲜冰冻血浆的比例分别为1.38∶1.00,1.58∶1.00,1.17∶1.00。不同基础疾病组患者术前血红蛋白水平、血小板计数和凝血指标存在差异,其中肝炎后肝硬化组血红蛋白值、血小板计数均显著低于原发性肝癌组;肝炎后肝硬化组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)显著长于原发性肝癌组,纤维蛋白原含量低于原发性肝癌组;不同基础疾病影响肝移植围术期成分输血量,其中肝炎后肝硬化组术中输注血浆、冷沉淀及血小板较原发性肝癌组显著性增多;肝炎后肝硬化组术后输注冷沉淀及血小板较原发性肝癌组显著性增多。127例肝移植患者中有46例接受术后TEG检测,结果提示患者为低凝状态,主要表现为纤维蛋白原活性降低、血小板活性降低,其中肝炎后肝硬化组凝血因子活性及纤维蛋白原功能均低于原发性肝癌组。结论:针对不同基础疾病所致肝移植术围手术期,选择科学、安全、合理的输血方案对肝移植成功率及患者预后至关重要,TEG检测对肝移植围手术期成分输血具有指导作用。     

评估老年骨折患者凝血状态常用方法的对比研究

目的:比较临床中评估老年骨折患者凝血状态的常用方法，探讨血栓弹力图(TEG)与常规凝血试验判断高凝状态的相关性及一致性。方法:收集2021年同时检测TEG与常规凝血试验的老年骨折患者290例为试验组，同期100例健康人作为对照组。检测2组的TEG参数与常规凝血指标进行相关性及一致性分析比较。结果:试验组与对照组的凝血凝固时间(K)、凝血形成速率(α角)、凝血最终强度(MA)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)比较差异有统计学意义(P<0.05)。TEG检测与常规凝血功能检测相关性分析表明，老年骨折患者的TEG参数中凝血反映时间(R)与凝血酶原时间(PT)呈正相关(r=0.314,P<0.05),与FIB呈负相关(r=-0.142,P<0.05);K与PT、TT呈正相关(r分别为0.201、0.184,P<0.05),与FIB呈负相关(r=-0.589,P<0.05);α角与FIB呈正相关(r=0.597,P<0.05),与PT、TT呈负相关(r分别为-0.200、-0.171,P<0.05);MA与APT...     

血栓弹力图与凝血指标在慢阻肺急性加重期患者中的对比分析

目的在慢性阻塞性肺疾病急性加重期(AECOPD)患者中检测血栓弹力图(TEG)与常规凝血指标,比较二者对AECOPD患者凝血功能的评估价值。方法前瞻性收集2017年2月至2018年5月我科住院治疗的AECOPD患者92例,根据患者过去一年内是否发生两次或以上急性加重或FEV_1%pred50%为标准,分为高风险组46例,低风险组46例,记录TEG的各项指标(R值、K值、Angle角度、MA值、CI);行常规凝血检测,包括凝血酶原时间(PT)、部分凝血活酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)、纤维蛋白/纤维蛋白原降解物(FDP)、凝血酶时间(TT)、D-二聚体(D-Dimer)、血小板(PLT)。回顾性分析高、低风险组AECOPD患者的TEG各指标与常规凝血指标间的差异;观察TEG各指标与常规凝血指标间的相关性,探讨TEG检测在评价AECOPD患者凝血功能中的应用价值。结果常规凝血各项指标在高风险组与低风险组间无明显差异(P0.05);AECOPD高风险组中TEG各项指标与低风险组比较差异有统计学意义(P0.05)。R与APTT低度相关(r=0.435);K与APTT低度相关(r=0.303),与PLT低度负相关(r=-0.372);MA与PLT中度相关(r=0.538),与FIB低度相关(r=0.462),与FDP低度负相关(r=-0.308),与D-Dimer低度负相关(r=-0.332);Angle角与PLT低度相关(r=0.422);CI与PLT低度相关(r=0.450);其他各参数无直线相关。结论对于高风险组AECOPD患者的凝血功能检测,TEG较常规凝血指标有一定优势。TEG与常规凝血指标相关性不高,不能相互替代,二者结合更利于掌握AECOPD患者的凝血状况。     

血栓弹力图在肝移植术后患者中的应用

目的探讨血栓弹力图(TEG)检测对肝移植术后患者合理使用血液成分的指导作用。方法选取2013年11月-2014年4月在首都医科大学附属北京佑安医院就诊的35例肝移植术后患者,采集患者的血液样本分别进行TEG检测和传统凝血项检测。选取TEG检测参数[凝血反应时间(R)、凝固时间(K)、凝固角(Angle)、血栓最大幅度(MA)]和凝血项指标进行双变量的直线相关分析,并对TEG检测指导临床使用血成分及输血量与临床申请输注血液情况进行比较。计量资料比较采用配对t检验。结果部分活化凝血酶原时间(APTT)、凝血酶原时间(PT)与R呈正相关(r值分别为0.69、0.41,P值分别为0.001和0.030);纤维蛋白原(FIB)与K呈负相关(r=-0.03,P=0.008);血小板(PLT)与Angle、MA呈正相关(r值分别为0.46、0.68,P值分别为0.029和0.000);FIB与MA呈正相关(r=0.33,P=0.040)。R值在TEG肝素酶杯中和前后差异具有统计学意义(P=0.027)。结论 TEG检测对肝移植术后患者合理使用血液成分具有指导意义。     

肝硬化患者凝血功能检测分析

目的分析肝硬化患者凝血指标随肝功能损害程度的变化,并探讨其临床意义。方法测定肝硬化组（50例）和对照组（40例）血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）和纤维蛋白原（FIB）。结果肝硬化组凝血指标与对照组比较,PT、APTT、TT均明显延长,差异有显著统计学意义（P〈0.01）,FIB明显下降,差异有统计学意义（P〈0.05）。肝硬化失代偿组PT、APTT、TT及FIB与代偿组比较,差异有显著统计学意义（P〈0.01）。结论凝血指标可以客观准确的评价肝硬化患者的凝血功能,能够发现早期肝病造成的凝血机制障碍,对肝硬化出血患者的抢救和治疗具有重要意义。     

Coagulation abnormalities in the trauma patient: the role of point-of-care thromboelastography

Current recommendations for resuscitation of the critically injured patient are limited by a lack of point-of-care (POC) assessment of coagulation status. Accordingly, the potential exists for indiscriminant blood component administration. Furthermore, although thromboembolic events have been described shortly after injury, the time sequence of post-injury coagulation changes is unknown. Our current understanding of hemostasis has shifted from a classic view, in which coagulation was considered a chain of catalytic enzyme reactions, to the cell-based model (CBM), representing the interplay between the cellular and plasma components of clot formation. Thromboelastography (TEG), a time-sensitive dynamic assay of the viscoelastic properties of blood, closely parallels the CBM, permitting timely, goal-directed restoration of hemostasis via POC monitoring of coagulation status. TEG-based therapy allows for goal-directed blood product administration in trauma, with potential avoidance of the complications resulting from overzealous component administration, as well as the ability to monitor post-injury coagulation status and thromboprophylaxis. This overview addresses coagulation status and thromboprophylaxis management in the trauma patient and the emerging role of POC TEG.     

Hämostaseologische Diagnostik und Therapie in der Intensivmedizin

Disorders in hemostasis, leading to hemorrhage or thrombembolic diseases, are of significant importance for intensive care unit (ICU) patients. Possible causes for hemostatic disorders are changes in thrombocyte count or function, changes in plasmatic coagulation or changes in fibrinolysis. Laboratory studies of hemostasis in ICU patients include platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) as well as measurement of fibrinogen, D-dimers and antithrombin. Except for platelet function disorders, for which no suitable screening test is currently available, the vast majority of clinically relevant disorders of hemostasis can be detected by the existing tests. Physicians in ICUs should have knowledge about possible conditions for pathologic test results, as wells as about conditions that interfere with the laboratory studies. Disorders in hemostasis in ICUs are mostly of complex and acquired origin. The differential diagnosis does not only have to consider the pathologic test result but also the underlying disease as well as the trend of the laboratory tests. In recent years, ?point-of-care testing“ has become more and more important in intensive care medicine. This method allows simple and rapid bedside hemostasis analysis. Of clinical importance in intensive care medicine are the following: activated clotting time (ACT) to monitor heparin administration and the so called rotatiol thrombelastography (ROTEG) to analyze clotting formation and stabilization. Platelet concentrates, fresh frozen plasma, blood coagulation factors as well as special pharmacological options are possible tools in the therapy of hemostasic disorders. Therapeutic decisions need to consider clinical aspects as well as the underlying hemostatic disorder and, last but not least, the availability of blood products, factor concentrates and advanced medical treatment.     

血小板参数、凝血功能指标与老年高血压患者发生体位性高血压的关系研究

背景 体位性高血压会增加中老年人群心血管疾病发生风险,而血小板参数与凝血功能指标是评估高血压患者缺血性心脑血管疾病发生风险的重要指标,故分析体位性高血压患者血小板参数和凝血功能指标变化有利于体位性高血压的诊治.目的 探究血小板参数、凝血功能指标与老年高血压患者发生体位性高血压的关系.方法 选取2020年9月至2021年...     

Blutungsneigung

Patients suffering from hemorrhagic disorders often present with only minimal bleeding during surgery or injuries. However, some patients have life-threatening bleeding. Simple screening tests can be used to find the cause of the bleeding: patient and family histories provide information on whether the bleeding tendency is hereditary or acquired. Clinical examination can reveal the bleeding type. Measurement of platelet count can be used to exclude thrombocytopenia. Coagulation tests, such as prothrombin time (PT, Quick) and activated partial thromboplastin time (aPTT) can supply initial information concerning deficiency states of coagulation factors. Bleeding time is often prolonged in patients suffering from von Willebrand disease, thrombocytopenia or thrombocytopathy. If—due to the results of these screening tests—further testing of particular coagulation factors or platelet function is needed, then patients should be referred to a centre specialized in blood coagulation.     

凝血功能指标、血栓前状态与子痫前期发病的关系

目的探究凝血功能指标、血栓前状态与子痫前期发病的关系。方法收集2016年3月至2018年8月黄石市中心医院收治的87例子痫前期患者为研究对象,其中轻度子痫前期组41例,重度子痫前期组46例。另同期选择于我院进行体检的40例正常妊娠晚期孕妇设为正常组。所有研究对象均于入院后抽取清晨空腹静脉血,检测活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、凝血酶原时间(prothrombin time,PT)及纤维蛋白原(fibrinogen,FIB)等凝血功能指标,以及D-二聚体(D-dimer,D-D)、凝血酶-抗凝血酶复合物(thrombin-antithrombin complex,TAT)、血小板颗粒膜蛋白-140(granule membrane protein-140,GMP-140)和血管性假性血友病因子(von Willebrand factor,VWF)等血栓前状态指标的浓度。结果随着子痫前期病情的进展,APTT、TT、PT均呈逐渐降低的趋势,正常组>轻度子痫前期组>重度子痫前期组,差异有统计学意义(P<0.05);D-D、TAT、GMP-140和VWF浓度均呈逐渐升高的趋势,正常组<轻度子痫前期组<重度子痫前期组,差异有统计学意义(P<0.05);而3组间的FIB浓度比较,差异无统计学意义(P>0.05)。结论子痫前期患者呈高凝、血栓前状态,并且随着病情严重程度的增加,凝血功能及血栓前状态相关指标的变化也更加明显。     

Hemorrhagic disorders

Patients suffering from hemorrhagic disorders often present with only minimal bleeding during surgery or injuries. However, some patients have life-threatening bleeding. Simple screening tests can be used to find the cause of the bleeding: patient and family histories provide information on whether the bleeding tendency is hereditary or acquired. Clinical examination can reveal the bleeding type. Measurement of platelet count can be used to exclude thrombocytopenia. Coagulation tests, such as prothrombin time (PT, Quick) and activated partial thromboplastin time (aPTT) can supply initial information concerning deficiency states of coagulation factors. Bleeding time is often prolonged in patients suffering from von Willebrand disease, thrombocytopenia or thrombocytopathy. If--due to the results of these screening tests-further testing of particular coagulation factors or platelet function is needed, then patients should be referred to a centre specialized in blood coagulation.     

Effects of recombinant activated factor VII on coagulation measured by thromboelastography in liver transplantation.

Besides the conventional laboratory tests, thromboelastography (TEG) is used to monitor hemostasis during liver transplantation. A previous pilot study suggested a beneficial effect of recombinant activated factor VII (rFVIIa) on transfusion requirements in liver transplantation. In the present study, we assess the effects of rFVIIa on coagulation variables and TEG. In six study patients, the prothrombin time (PT), the activated partial thromboplastin time (aPTT) and TEG variables [reaction time (r), kinetic time (k), or clot formation time, alpha angle (alpha), and maximal amplitude (MA)] were recorded before and after the administration of a bolus of 80 microg/kg rFVIIa. These patients were compared with six controls who did not receive rFVIIa. In contrast with the control group, a significant shortening of PT (P = 0.028) and aPTT (P = 0.028), r (P = 0.046) and k (P = 0.043) values, and a significant incline of the alpha angle (P = 0.028) were noticed after injection of rFVIIa, whereas MA increased not significantly (P = 0.075). rFVIIa rapidly improved coagulation variables in liver transplant patients including PT and aPTT. Of the TEG variables, r, k and alpha angle significantly improved, and MA showed a trend to increase. These data suggest that rFVIIa not only influences the speed of clot formation, but also the physical properties of the clot, which cannot be detected by routine coagulation tests.     

Influence of direct thrombin inhibitor argatroban on coagulation assays in healthy individuals, patients under oral anticoagulation therapy and patients with liver dysfunction.

We assumed that argatroban, a direct thrombin inhibitor, has a strong influence on different coagulation tests which is even more pronounced in patients with an established reduced factor activity like those under oral anticoagulation therapy or with liver dysfunction. To validate this influence we spiked plasma samples from healthy individuals, patients under oral anticoagulation therapy or with liver dysfunction with increasing argatroban concentrations (0-2000 ng/ml) and performed routine laboratory coagulation tests. Consequently, prothrombin time, activated partial thromboplastin time, thrombin time, batroxobin time, coagulation factor activity (FII-FXIII), protein S (activity), protein C (chromogen) and fibrinogen (derived and Clauss fibrinogen method) were measured. Furthermore, the influence of argatroban on the induced platelet aggregation was evaluated. Argatroban interference on standard coagulation assays differed markedly depending on the different subgroups of patients investigated. Prolongation of prothrombin time by argatroban (at 2000 ng/ml 2.7-fold in healthy persons) was significantly higher in oral anticoagulation therapy (3.9-fold) and even more pronounced in liver dysfunction (6.0-fold). The fibrinogen concentration was determined falsely even at low-argatroban concentrations using functional methods in healthy persons and all patient subgroups. The influence of argatroban on standard laboratory coagulation tests is significantly increased by a preexisting factor deficiency. Functional fibrinogen measurement may be helpful to assess in-vivo fibrinogen function but should be avoided to evaluate fibrinogen concentration in argatroban treated patients. Argatroban had no influence on chromogenic protein C measurement, batroxobin time and induced platelet aggregation. Knowledge of argatroban interference is a prerequisite for the reliable interpretation of coagulation assays.     

Activation of Coagulation in Cirrhotics after Endoscopic Variceal Schlerotherapy

To investigate the occurrence and extent of activation of coagulation after endoscopic variceal sclerotherapy (EVS), we performed serial measurements of conventional coagulation tests [prothrombin time (PT), partial thromboplastin time (PTT), platelets, and fibrinogen], and of plasma fibrinopeptide A (FPA) in 39 cirrhotic patients undergoing 55 sessions of elective EVS. Thrombin (20 U/ml) and sodium morrhuate 5% were used in sequence as sclerosants on 34 occasions. In the remaining 21 sessions, sodium morrhuate 5% alone was used. Conventional coagulation tests did not change significantly after EVS, regardless of the type of treatment. Basal plasma FPA levels were abnormally high in about 50% of patients. After EVS, plasma FPA increased sharply in 37/39 patients (95%), returning to baseline values in most of them within 24 h. We conclude that transient systemic activation of blood coagulation occurs after EVS. Such activation can be detected only by sensitive methods such as FPA assay, and has no effect on conventional coagulation tests. This, and the absence of any clinical EVS-related coagulation disorder in our patients, suggests that activation of coagulation should not be a major concern for patients undergoing EVS.