2020 年第 12 期 第 15 卷

血栓弹力图指导急性Stanford A型主动脉夹层围术期成分输血的价值分析

Value analysis of thromboelastography in guiding the perioperative blood component transfusion in patients with acute Stanford type A aortic dissection

作者：白杨1孙孟尧1张清政1张九江1曹振环1龙盼2

英文作者：Bai Yang1 Sun Mengyao1 Zhang Qingzheng1 Zhang Jiujiang1 Cao Zhenhuan1 Long Pan2

单位：1吉林大学第一医院心脏外科，长春130021；2上海德达医院重症监护室201702

英文单位：1Department of Cardiac Surgery the First Hospital of Jilin University Changchun 130021 China; 2Intensive Care Unit Shanghai Delta Hospital Shanghai 201702 China

关键词：主动脉夹层；血栓弹力图；成分输血

英文关键词：Aorticdissection;Thromboelastography;Bloodcomponenttransfusion

• 摘要：

• 目的 探讨血栓弹力图（TEG）在指导急性Stanford A型主动脉夹层患者围术期成分输血中的临床应用价值。方法  选取2017年1月至2019年12月于吉林大学第一医院心脏外科行急性Stanford A型主动脉夹层手术患者98例，按照随机数字表法分为TEG组及对照组，各49例。TEG组患者进行TEG检测，并根据TEG情况指导术中及术后输注血浆、冷沉淀及血小板，对照组术中及术后给予经验性输血。手术前后检测2组患者的血红蛋白、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤维蛋白原（FIB）水平。术后常规监测引流量、血液制品使用种类及输血量、术后呼吸机时间、重症监护病房（ICU）停留时间、住院时间并进行比较。结果   TEG组术中血浆、冷沉淀及血小板输注量均明显低于对照组，呼吸机时间、ICU停留时间明显短于对照组，术后24 h引流量明显少于对照组（均P＜0.05）。2组住院时间比较差异无统计学意义（P＞0.05）。术后24 h输血量分析结果显示，TEG组的红细胞悬液、血浆、冷沉淀及血小板输注量均明显少于对照组［（10.6±2.5）IU比（15.6±5.7）IU、（2 100±516）ml比（2 720±890）ml、（16±5）IU比（20±0）IU、（1.0±0.9）IU比（2.0±0.0）IU］（均P＜0.05）。2组间术后24 h的血红蛋白、PLT、PT、APTT及FIB水平比较差异均无统计学意义（均P＞0.05）。结论  TEG用于指导急性Stanford A型主动脉夹层手术患者的围术期成分输血，可有效减少围术期输血量，缩短ICU停留时间。TEG可作为指导急性Stanford A型主动脉夹层围术期成分输血的理想策略。

• Objective  To investigate the clinical value of thromboelastography (TEG) in guiding perioperative blood component transfusion in patients with acute Stanford type A aortic dissection. Methods From January 2017 to December 2019, 98 patients with acute Stanford type A aortic dissection were collected from the department of cardiac surgery in the First Hospital of Jilin University. They were randomly divided into TEG group and control group, and with 49 cases in each group. In TEG group, intraoperative and postoperative infusion of plasma, cryoprecipitation and platelets were guided according to the results of TEG. Patients in control group were given a perioperative empirical blood transfusion. Routine blood test ［hemoglobin, platelet count(PLT)］ and coagulation function ［prothrombin time(PT), activated partial thromboplastin time(APTT) and fibrinogen(FIB)］ were tested before and after surgery. The drainage volume, the types and amount of transfusion blood products, postoperative ventilator time, intensive care unit (ICU) stay, and hospitalization time were compared between the two groups after the surgery. Results The volume of blood plasma, cryoprecipitate, platelet transfusion and volume of drainage 24 h after operation in TEG group were significantly lower than those in control group, the time of ventilator and ICU stay were significantly shorter than those in control group (all P＜0.05). There was no significant difference in hospitalization time between the two groups (P＞0.05). The results of 24 h blood transfusion volume analysis showed that red blood cell suspension, plasma, cryoprecipitate and platelet transfusion volume in TEG group were significantly lower than those in control group［（10.6±2.5）IU vs （15.6±5.7）IU,（2 100±516）ml vs （2 720±890）ml,（16±5）IU vs （20±0）IU,（1.0±0.9）IU vs （2.0±0.0）IU，all P＜0.05］. There were no significant differences in hemoglobin, PLT, PT, APTT and FIB levels between the two groups (all P＞0.05). Conclusion TEG can be used to guide perioperative blood component transfusion for the patients with acute Stanford type A aortic dissection, which can effectively reduce the perioperative blood transfusion volume and shorten ICU stay time. TEG can be used as an ideal strategy to guide perioperative component transfusion of acute Stanford type A aortic dissection.