| TEG对比常规凝血检查在血浆置换和连续性血液净化治疗肝衰竭中的应用 |
| 投稿时间：2016-02-07 修订日期：2016-03-03 点此下载全文 |
| 引用本文：刘远志,李鹏,张月宁,丁惠国,张世斌.TEG对比常规凝血检查在血浆置换和连续性血液净化治疗肝衰竭中的应用[J].医学研究杂志,2016,45(9):122-125,129 |
| DOI：
10.11969/j.issn.1673-548X.2016.09.032 |
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| 中文摘要:目的 比较血栓弹力图（TEG）与常规凝血检查在肝衰竭患者的血浆置换、连续性血液净化治疗中的一致性，评价TEG在肝衰竭患者安全治疗中的应用价值。方法 所有研究对象在治疗前均已接受凝血功能和TEG检查。以56例成功实施血浆置换的肝衰竭患者为研究对象，在治疗后进行凝血常规、TEG检查，分析比较二者在治疗前后的差异。再分别以凝血酶原活动度（PTA）和凝血指数（CI）作为常规凝血和TEG的主要检测指标，比较二者结果的一致性。以同期进行连续性血液净化的47例肝衰竭患者，以最终治疗时间为标准将患者分为<6h组、6~12h组、≥12h组，分别以实际治疗时间、6h、12h为监测终点，复查凝血常规和TEG，分别比较两种检查方法在不同组中结果的差异。结果 血浆置换后，两种检查均提示患者凝血功能得到改善，其中，常规凝血检查4项指标较治疗前均显著改善（P均=0.000）；TEG中R值明显减少（P=0.000），α角扩大（P=0.043），CI显著改善（P=0.000）。但二者检测结果的一致性明显不同，CI比PTA的改善更为明显（P<0.05）。在连续性血液净化治疗中，<6h组患者，两种检查所有指标均提示凝血功能无改善（P均>0.05）；6~12h组患者，常规凝血检查所有指标均提示凝血功能无改善（P均>0.05），而TEG中R值明显延长，CI明显恶化（P<0.01）；≥12h组患者，两种检查均发现凝血功能明显变差（P<0.05）。结论 肝衰竭患者在血浆置换、连续性血液净化治疗前后，TEG与常规凝血检查结果并不完全一致，且TEG对治疗后患者凝血状态的改变更为敏感、准确，对肝衰竭患者安全治疗的监测可能更有帮助。 |
| 中文关键词:血栓弹力图 血液净化 肝衰竭 |
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| Application of TEG and Routine Coagulation Test in the Treatment of Liver Failure with Plasma Exchange and Continuous Blood Purification |
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| Abstract:Objective To compare the difference between thrombelastogram (TEG) and routine coagulation test in two methods of plasma exchange and continuous blood purification (CBP).To evaluate the value of TEG in the safe treatment of patients with liver failure. Methods All subjects received routine coagulation test and TEG before treatment.56 patients with liver failure who were successfully treated with plasma exchange were the subjects, and the routine coagulation test and TEG to compare the differences between before and the treatment. Prothrombin activity (PTA) and blood coagulation index (CI) were used as the main indexes of conventional coagulation and TEG, the results were compared with those of the two. 47 patients of liver failure patients with continuous blood purification were the subjects. The cases were divided into three groups: <6 h group, 6-12h group, ≥12 h group based on the treatment time. Respectively, we set the actual treatment time, 12h, 6h as the monitoring endpoint respectively, reexamined routine coagulation test and TEG, to compare the differences between two methods in different groups. Results After plasma exchange, two kinds of tests showed that the coagulation function was improved. The four indexes of routine coagulation tests were significantly improved (P=0.000); the response time (R) in TEG was significantly decreased (P=0.000),CI was significantly improved(P=0.000).But the consistency of the results of the two test was significantly different, the improvement of CI was more obvious than that of PTA(P<0.05).In the treatment of continuous blood purification,for <6h group, all two tests showed that the patients' coagulation function was not improved.For 6-12h group, all the indexes of routine coagulation tests showed no improvement of coagulation function(P>0.05), R in TEG significantly prolonged, CI was significantly deteriorated(P<0.01).For ≥12h group, two kinds of tests showed that the coagulation function was significantly different(P<0.05). Conclusion TEG was not completely consistent with the results of routine coagulation tests in patients with liver failure before and after plasma exchange, continuous blood purification. TEG may be more sensitive and accurate to the changes of blood coagulation status after treatment and more helpful in monitoring the safety of patients with liver failure. |
| keywords:TEG Blood purification Liver failure |
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