血栓弹力图指导体外循环心脏手术围术期输血对患者出血量、输血量和临床结局的影响

目的 比较血栓弹力图(TEG)和传统凝血指标(SCT)指导体外循环(CPB)心脏手术围术期输血对患者出血量、输血量和临床结局的影响。 方法 将浙江省人民医院2016年6月—2017年5月收治的96例择期CPB心脏手术患者按随机数字表法分为TEG组(T组)和SCT组(C组)。2组均于手术期间每次自体血液回输结束时、手术结束后24 h内患者引流量>300 mL/h时检测HB，若＜70 g/L，输入异体RBC；同时2组在上述时点分别检测TEG或SCT，按TEG或SCT结果输入新鲜冰冻血浆(FFP)、血小板(PLT)及纤维蛋白原(FIB)。记录2组围术期出血量、输液量、自体血液及异体血液(RBC、FFP及PLT)输入量；记录2组气管插管时间、ICU驻留时间、术后24 h内因出血过多再次手术例数、死亡例数及住院天数。 结果 2组围术期出血量、输液量、自体血液及异体RBC输入量差异无统计学意义(均P>0.05)；T组围术期FFP及PLT输入量小于C组(均P<0.05)；2组气管插管时间、ICU驻留时间、术后24 h内因出血过多再次手术例数、死亡例数及住院天数差异无统计学意义(均P>0.05)。 结论 TEG指导CPB心脏手术围术期输血可以减少患者FFP和PLT输入量，不影响出血量、RBC输入量及临床结局。 

Comparison of thromboelastography and standard coagulation tests guided perioperative period transfusion in patients undergoing cardiac surgery with cardiopulmonary bypass

Objective To compare the effect and safety of thromboelastography and standard coagulation tests guided perioperative period transfusion in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods Ninety-six patients undergoing cardiac surgery with cardiopulmonary bypass were randomly divided into group TEG (group T, n=48 ) and group SCT (group C, n=48). The perioperative period transfusion in Group T was guided by TEG, and in Group C by SCT. The volume of haemorrhage and the consumption of different blood components during perioperative period were recorded; the incidence of reoperation or die, and the intubation time and length of ICU stay and hospitalization time of both groups were also observed. Results There were no difference in the volume of haemorrhage, the consumption of fluid crystalloid and colloid, the consumption of autologous blood and allogeneic RBC between the two groups (all P>0.05). The consumption of allogeneic FFP and PLT were significant decreased in Group T as compared wht Group C(all P<0.05). There were no difference in the incidence of reoperation or die and the intubation time and length of ICU stay and hospitalization time between the two groups (all P>0.05). Conclusion Compared with SCT, TEG guided transfusion algorithm may reduce the consumption of allogeneic FFP and PLT, while not elevate the volume of haemorrhage and RBC input and not decrease the clinical efficacy.