血栓弹力图指导血液制品输注对弥散性血管内凝血患者凝血功能及预后的影响

董莹莹

【摘要】 目的：分析血栓弹力图（TEG）指导血液制品输注对弥散性血管内凝血（DIC）患者凝血功能及预后的影响。方法：选取2015年6月-2018年5月本院收治的60例DIC患者。按随机数字表法将患者分为观察组与对照组，各30例。对照组以常规凝血指标为指导、观察组以TEG为指导进行血液制品输注。评估两组24 h输血量、抗凝治疗情况、血液输注前后凝血功能（PT、APTT、TT、FIB）变化以及预后情况。结果：观察组24 h内血浆、血小板、冷沉淀输注量均显著少于对照组（P<0.05）;观察组肝素使用率、肝素使用总剂量及总治疗天数均明显少于对照组（P<0.05）;输注后，观察组PT、APTT、TT均低于对照组，FIB高于对照组，差异均有统计学意义（P<0.05）;观察组DIC症状改善率明显高于对照组，ICU住院时间明显短于对照组，差异均有统计学意义（P<0.05）。结论：相较于常规凝血指标，以TEG为指导对DIC患者通过输血纠正异常的凝血功能的效果更理想，患者预后更佳，且利于避免或者减少血制品滥用。

【关键词】 血栓弹力图; 弥散性血管内凝血; 血液制品输注; 指导作用

【Abstract】 Objective：To analyze the effect of thromboelastography（TEG）guides blood product infusion on coagulation function and prognosis in patients with disseminated intravascular coagulation（DIC）.Method：A total of 60 DIC patients admitted to our hospital from June 2015 to May 2018 were selected，according to random number table method，they were divided into observation group and control group，30 cases in each group.The control group was guided by routine coagulation index，while observation group was guided by TEG for blood product transfusion.The 24-hour blood transfusion volume，anticoagulationtherapy，changes of coagulation function（PT，APTT，TT，FIB）before and after blood transfusion and prognosis in two groups were evaluated.Result：The amount of plasma，platelet and cryoprecipitate transfusion in observation group were less than those of control group within 24 hours（P<0.05）.The usage rate of heparin，total dose of heparin and total treatment days in observation group were less than those of control group（P<0.05）.After infusion，the PT，APTT and TT in observation group were lower than those of control group，and FIB was higher than that of control group，the differences were statistically significant（P<0.05）.The improvement rate of DIC symptoms in observation group was higher than that of control group，and the hospitalization time in ICU was shorter than that of control group，the differences were statistically significant（P<0.05）.Conclusion：Compared with routine coagulation index，TEG is more effective in correcting abnormal coagulation function by blood transfusion in DIC patients，and has better prognosis，and is conducive to avoiding or reducing the abuse of blood products.

【Key words】 Thromboelastography; Disseminated intravascular coagulation; Blood product infusion;Guiding role

First-authors address：Jiamusi Central Hospital，Jiamusi 154002，China

doi：10.3969/j.issn.1674-4985.2019.16.009

彌散性血管内凝血（Disseminated intravascular coagulation，DIC）是基于多种疾病、致病因子损伤全身微血管系统，导致凝血活化、微血管血栓形成，凝血与抗凝系统失衡，凝血因子大量损耗并继发纤溶亢进，引起以全身多处出血、微循环障碍为特点的临床综合征。相关资料显示，DIC常继发于重症感染、严重创伤、肿瘤以及血管异常等疾病中，亦可并发于中毒、严重免疫反应疾病以及妊娠相关疾病中[1-3]。同时发生多处微血管血栓形成及难以控制的出血倾向是DIC的典型特征，若未经及时有效救治，将逐渐发展为多器官功能障碍综合征，预后差，死亡率高[4]。临床实践证实，针对性对DIC不同阶段合理补充血液制品为DIC治疗关键环节，早期临床上一般根据凝血指标指导输注血液制品种类及输注量，但效果有限[5-6]。本院近年来将血栓弹力图（Thromboelastography，TEG）引入到了DIC患者凝血功能的动态监测中，通过图像不但可以观察到血液凝固的动态过程，还可以监测到纤维蛋白形成过程的动力学变化，其在指导血液制品输注上发挥了理想作用，现报道如下。……