血栓弹力图对肝素抗凝患者血液成分输注指导初探

20143611··（thrombelastogram,TEG），[1]。[2，3]。TEG，，TEG，。、20115201212300，，87。，47，40；15~82，（74±18），高晓云贾军会王新华田华【】（TEG）。300，87。（CK-TEG）（CKH-TEG），TEG，。R、K、Angle、CI（P0.05），（P0.05）。CKH-TEG，，。【】ValueofthromboelastographinguidingbloodcomponentstransfusioninpatientswithheparinGaoXiaoyun,JiaJunhui,WangXinhua,TianHua.DepartmentofBloodTransfusion,AerospaceCentralHospital,Beijing100049,ChinaCorrespondingauthor：WangXinhua，Email：[e-mail]【Abstract】ObjectiveToinvestigatethevalueofthromboelastographinguidingbloodcomponentstransfusioninpatientswithheparinanticoagulantiontherapy.MethodsThreehundredpatientswithheparinanticoagulantiontherapywereselectedtomeasureconventionalcoagulationtests.Patientswithcoagulopathywereselectedasresearchsubjects.Cit-ratedkaolin-activatedsamplesthrombelastometry(CK-TEG)andcitratedkaolin-activatedsamplesthrombelastometrytestsinheparinscup(CKH-TEG)weremeasuredrespectivelyfortheresearchsubjects.TheparametersbetweenCK-TEGandCKH-TEGwerecompared,andtheneedofbloodcomponentstransfusionbeforeandaftertheheparinscupneutralizationwerecompared.ResultsTheresultofTEGtestsshowedthatthevaluesofR、K、AngleandCIweresignificantlydifferentbetweenCK-TEGandCKH-TEGtests(P0.05),andtherewassignificantdifferenceintheneedofplasmaandplatelettransfusionbeforeandafterheparinscupneutralization(P0.05).ConclusionSincetheinterferenceofheparintoan-ti-coagulationtestscouldbeexcluded,thethromboelastographytestcanaccuratelyreflectthetruecoagulationstatusofpatient,andguidethebloodcomponentstransfusioninpatientswithheparintherapy.【Keywords】ThromboelastographyHeparinBloodcoagulationtestsBloodtransfusion：100049，：，Email：[e-mail]:j.0253-9713.2014.11.025··961··20143611、、、、、。、EDTA2ml，（PLT）。1∶92，2.7ml。[（APTT），（PT）]，（CK-TEG）（CKH-TEG），TEGThrombelasto-graphHemostasisSystem5000，。。TEG5000。、SPSS16.0。x軃±s，t。P0.05。、87，APTT149s41，APTT149s31，PT15；PLT50×109/L38。、TEGCK-TEG37，50；37R，TEG。CKH-TEG，TEG。37CK-TEGCKH-TEG（R）[（50.6±14.6）minvs.（11.4±4.6）min，P0.05]。50CK-TEGCKH-TEGTEG，1。2。、2TEG2TEG、TEG，87，41，48（3）。2TEG，CK-TEGCKH-TEG[（370±377）mlvs.（76±147）ml，（0.6±0.8）Uvs.（0.3±0.6）U，P0.05]。[4]。APTT，、、，。（ACCP）8，0．3U/ml，APTT48s108s[5]。TEGCK-TEGCKH-TEGtPR（min）12.9±8.27.7±2.24.3930.05K（min）6.1±7.62.6±1.53.1760.05Angle（deg）46.6±20.757.3±12.23.1490.05MA（mm）50.5±13.453.2±11.71.0800.05CI：R，；K，；MA，；CI，-8.8±10.4-2.9±3.53.7970.05150CK-TEGCKH-TEG（x軃±s）TEGCK-TEGCKH-TEGR，MA04810R≤204621R20410MA51191110R≤20，MA51：R，；MA，16722TEG（）CK-TEGCKH-TEG52211911+167873932TEG（）962··20143611，APTTAPTT。APTT、PTTEG、，TEG，。TEG，，RCKH-TEGCK-TEG，TEG，，。K、Angle、CITEG，CK-TEG，TEGCK-R，CKH-TEG。，，，。CKH-TEGCK-TEG，，TEGCKH-TEG，，。[1]KangYG,MartinDJ,MarquezJ,etal.Intraoperativechangesinbloodcoagulationandthrombelastographicmonitoringinlivertransplantation[J].AnesthAnalg,1985,64:888-896.[2]CoppellJA,ThalheimerU,ZambruniA,etal.Theeffectsofun-fractionatedheparin,lowmolecularweightheparinanddanaparoidonthethrombelastogram(TEG):aninvitrocomparisonofstan-dardandheparinasemodifiedTEGswithconventionalcoagulationassays[J].BloodCoagulFibrinolysis,2006,17:97-104.[3]Shore-LessersonL,ManspeizerHE,DePerioM,etal.Thromboe-lastography-guidedtransfusionalgorithmreducestransfusionsincomplexcardiacsurgery[J].AnesthAnalg,1999,88:312-319.[4]ParkSH,LeeSW,JeonU．Transcatheterarterialembolizationastreatmentforalife-threateningretroperitonealhemorrhagecom-plicatingheparintherapy[J].KoreanJInternMed,2011,26:352-355.[5]HirahJ,BauerKA,DonatiMB,etal．Parenteralanticoagulants：AmericanCollegeofChestPhysiciansEvidence-BasedClinicalPracticeGuidelines(8thed)[J].Chest,2008,133:141s-159s.（：2013-06-18）····，23，20131110，，ABO。B，A。242，，A2U。，ABO、RhD、；，A、RhD。：DGGelABO-CDE（DiagnosticGrifols，Spain，LOT12017.01），A1、B（Diag-nosticGrifols，Spain，LOT12043.01），（Di-agnosticGrifols，Spain，LOT12011.01），DGGelCoombs（DiagnosticGrifols，Spain，LOT12096.01），IgG-A1侯瑞琴孙泳田文沁：（RDB2014-16）：100044：，Email：[e-mail]:j.0253-9713.2014.11.026（下转第965页）963··