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OACSTPCD
Thromboelastography and routine coagulation tests in the management of coagulation during ECMO therapy:a comparative study
目的 探讨血栓弹力图(thromboelastography,TEG)与常规凝血试验各参数的相关性和一致性,评价 2 种方法在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持治疗患者肝素抗凝监测及凝血功能监测中的应用价值.方法 选取 2021 年 10 月—2022 年 12 月就诊于广西壮族自治区人民医院重症医学科的 138 例ECMO支持治疗的患者,对同步检测的共 317 对普通TEG、肝素酶纠正的血栓弹力图(heparinase-modified thromboelastogra-phy,hmTEG)参数与活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、血小板计数(Plt)等指标进行相关性及一致性分析,并对ECMO建立时和ECMO运行 24h后的指标进行比较.结果 hmTEG的凝血反应时间(R)与APTT的相关系数(r=0.441,P<0.05)低于普通TEG R值与APTT的相关系数(r=0.547,P<0.05);普通TEG的凝固角(α-An-gle)、凝血形成时间(K)与Fib无相关关系(P>0.05),而hmTEG 的α-Angle、K与Fib的相关系数分别为 0.359(P<0.05)、-0.343(P<0.05);hmTEG的最大振幅(MA)与Plt的相关性为 0.456(P<0.05),远低于其与Fib的相关性(r=0.715,P<0.05).APTT和hmTEG对ECMO支持治疗患者普通肝素抗凝效果的判断具有中度的一致性(P<0.05).ECMO上机 24h后Plt明显低于ECMO建立时(P<0.05),而Fib、APTT及hmTEG各参数等指标在两者间比较差异均无统计学意义(P>0.05).结论 hmTEG可以更好地反映ECMO支持治疗患者真实的凝血因子功能水平,使用hmTEG和APTT评估ECMO支持治疗患者肝素是否超量的结果可以相互参考,且hmTEG具有独特的优势.常规凝血试验和TEG检测不能相互替代,联合应用利于实现更好地抗凝和凝血管理.
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.
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
广西壮族自治区人民医院 输血科,广西 南宁 530021广西医学科学院传染病与急危重症救治研究所广西壮族自治区人民医院重症医学科
临床医学
体外膜肺氧合血栓弹力图常规凝血试验抗凝
extracorporeal membrane oxygenation(ECMO)thromboelastography(TEG)routine coagulation testsan-ticoagulation
《中国输血杂志》 2024 (006)
613-619 / 7
广西卫生健康委科研课题(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)
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