血栓弹力图指导下调节肝硬化脾切除围手术期凝血功能的临床观察

目的 用血栓弹力图（thrombelastography,TEG）指导调节肝硬化脾切除围手术期凝血功能,探讨其临床意义.方法 61例肝硬化患者脾切除围手术期在TEG指导下输注血液成分,50例肝硬化患者在常规凝血指导下输注血液成分,比较2组术后肝功能主要参数,以及手术时间、术中出血量和住院时间.结果 肝硬化脾切除围手术期,与术前比较,TEG组术后R、K值明显降低（P＜0.01）;Plt、α角、MA、CI、FIB值均显著增大（P＜ 0.01）.输注血小板29例（47.5％）,输注冷沉淀17例（27.9％）,联合输注6例（9.8％）.术后PT、APTT与术前差异无统计学意义（P＞0.05）.对照组术后Plt、FIB值显著增大（P＜0.01）.术后PT、PTA、INR、APTT与术前差异无统计学意义（P＞0.05）.输注血小板23例,占46.0％,输注冷沉淀6例,占12.0％,联合输注6例,占12.0％.2组术前差异无统计学意义（P＞0.05）,术后肝功能较术前均有所改善（P＜0.05）.与对照组比较,TEG组AST降低,ALB升高（P＜0.05）,出血量、手术时间、住院时间明显减少（P＜0.05）.结论 TEG相比常规凝血检查能够更准确的评估肝硬化脾切除围手术期凝血功能状态.TEG证实部分肝硬化患者存在凝血再平衡现象.TEG还需更多的临床试验来研究和指导调节肝硬化患者凝血功能.

Regulation of Coagulation Function in Patients with Cirrhosis Splenectomy by Thromboelastography

Objective To investigate the coagulation function by thromboelastography and its clinical impact in patients with cirrhosis splenectomy.Methods 61 patients with cirrhosis splenectomy were treated with component transfusion under the guidance of TEG,and other 50 patients with cirrhosis splenectomy were treated with component transfusion under the guidance of conventional clotting tests.Liver function,the operative time,blood loss and hospitalization time was recorded and compared between the two groups.Results In TEG group,compared with the preoperative,the postoperative time ofTEG R and K was shorter （P＜0.01）,Plt,α angle,MA,G and CI was increased （P＜0.01）.29 cases were treated with platelet （47.5％）,17 cases were treated with cryoprecipitate （27.9％）,6 cases were treated with platelet and cryoprecipitate （9.8％）.There was no significant difference reported between preoperative and postoperative in PT and APTT （P ＞0.05）.In control group,compared with the preoperative,the postoperative Plt and FIB was increased （P＜0.01）.There was no significant difference between preoperative and postoperative in PT,PTA,INR and APTT （P＞0.05）.23 cases were treated with platelet （46.0％）,6 cases were treated with cryoprecipitate （12.0％）,6 cases were treated with platelet and cryoprecipitate （12.0％） Compared with the preoperative,postoperative liver function was improved in both groups （P＜0.05）.Compared with the control group,AST was decreased,ALB was increased,and the operative time,blood loss and hospitalization time was decreased in TEG group （P＜0.05）.There was no significant difference between two group in preoperative （P ＞0.05）.Conclusion TEG provides a better assessment of coagulation function than conventional clotting tests in patients with cirrhosis splenectomy.TEG in patients with cirrhosis have suggested that rebalanced hemostasis exists in some patients.TEG needs to be clinically validated in terms of more clinical trials to study and regulate