中国输血杂志2024，Vol.37Issue(6)：613-619,7.DOI:10.13303/j.cjbt.issn.1004-549x.2024.06.001
血栓弹力图与常规凝血试验应用于ECMO治疗中止凝血管理的对比研究
Thromboelastography and routine coagulation tests in the management of coagulation during ECMO therapy:a comparative study
摘要
Abstract
Objective To investigate the correlation and consistency between the parameters of thromboelastography(TEG)and routine coagulation tests,and to evaluate the application value of the two methods in heparin anticoagulation monitoring and coagulation function monitoring in patients receiving extracorporeal membrane oxygenation(ECMO)therapy.Methods A total of 138 patients who recieved ECMO in the Department of Critical Care Medicine of the People's Hospital of Guangxi Zhuang Autonomous Region from October 2021 to December 2022 were selected.A total of 317 pairs of ordinary TEG and heparinase-modified TEG(hmTEG)parameters measured simultaneously were analyzed for correlation and consis-tency with activated partial thromboplastin time(APTT),fibrinogen(Fib),and platelet count(Plt),and the parameters tested when ECMO was established and 24 hours after ECMO operation were compared.Results The correlation coefficient between R values and APTT of hmTEG(r=0.441,P<0.05)was lower than that of ordinary TEG(r=0.547,P<0.05).The parameters α-Angle and K value of ordinary TEG were not correlated with Fib(P>0.05),while as for hmTEG,the correla-tion was 0.359(P<0.05)and-0.343(P<0.05),respectively.The correlation between MA value of hmTEG and Plt was 0.456(P<0.05),which was much lower than its correlation with Fib(r=0.715,P<0.05).APTT and hmTEG had moderate agreement in judging the anticoagulant effect of UFH(P<0.05).Plt at 24 hours after ECMO was significantly lower than that at establishment of ECMO(P<0.05).Fib,APTT and hmTEG parameters were not significantly different between the two groups(P>0.05).Conclusion The parameters of hmTEG can better reflect the real level of coagulation factors in patients receiving ECMO.The results of hmTEG and APTT are complementary to assess whether heparin in ECMO patients is over-dosed,and hmTEG has unique advantages.Routine coagulation tests and TEG cannot replace each other,and the combina-tion of them can achieve better anticoagulation and coagulation management.关键词
体外膜肺氧合/血栓弹力图/常规凝血试验/抗凝Key words
extracorporeal membrane oxygenation(ECMO)/thromboelastography(TEG)/routine coagulation tests/an-ticoagulation分类
医药卫生引用本文复制引用
李豪,李思娜,黄惠妮,阳子骥,谢慧琼,罗瑞献,向淑麟,黎海澜,莫柱宁..血栓弹力图与常规凝血试验应用于ECMO治疗中止凝血管理的对比研究[J].中国输血杂志,2024,37(6):613-619,7.基金项目
广西卫生健康委科研课题(Z-A20220131) （Z-A20220131）
广西重大传染性疾病重症救治临床医学研究中心(桂科AD22035101) （桂科AD22035101）
