中国输血杂志2024，Vol.37Issue(6)：625-631,7.DOI:10.13303/j.cjbt.issn.1004-549x.2024.06.003
血栓弹力图在膝关节镜手术预防下肢肌间静脉血栓中的应用
Clinical application of thromboelastography in the prevention of lower extremity intermuscular venous thrombosis after knee arthroscopy
摘要
Abstract
Objective To explore the guiding value of thromboelastography(TEG)in the formulation of personalized anticoagulation regimen after knee arthroscopy.Methods A total of 50 patients who underwent knee arthroscopy in our hos-pital from April to August 2023 were randomly divided into two groups.Twenty-seven patients with routine anticoagulation were selected as the control group,and 23 patients with personalized anticoagulation were selected as the experimental group.Conventional anticoagulation was a prophylactic dose of low molecular weight heparin calcium(LMWHC)selected according to body weight,once a day to 7 days after surgery.Personalized anticoagulation was performed according to the prophylactic dose of LMWHC until postoperative day 3.On postoperative day 3,LMWHC was changed to aspirin according to the TEG return index(MA>70 mm,α Angle>72°,K value<1 min),and the initial prophylactic dose was 100 mg/d.LMWHC was changed to rivaroxaban when R<5 min,and the prophylactic dose was 10 mg/d until postoperative day 7.Pa-tients with hypocoagulation or subcutaneous ecchymosis stopped the drug first,and if it was further aggravated,component blood transfusion was performed according to the TEG results.The difference of Caprini score in perioperative period,the correlation between TEG and CCT on postoperative day 1,and the accuracy of predicting thrombosis on postoperative day 7 were compared between the two groups using the receiver operating characteristic curve(ROC).Results There was a sig-nificant difference in Caprini score between the two groups at 7 days after operation(P<0.05),suggesting that the adjust-ment of anticoagulant drugs in the experimental group was effective at 3 days after operation.Pearson correlation evaluation showed that there was a strong positive correlation between maximum coagulation intensity(MA)in TEG and platelet(Plt)in CCT at day 1 after surgery(P<0.05).Thrombosis was found in the control group at 7 days after operation,all of which were CMVT and disappeared after therapeutic antithrombotic therapy.MA was included in the ROC curve for model analysis.The area under the ROC curve(AUC)of the control group was 0.819,and the AUC of the experimental group was 0.508.It was found that the control group model had higher accuracy in predicting the formation of CMVT.Conclusion Individu-alized anticoagulation under TEG monitoring can effectively reduce the occurrence of CMVT after knee arthroscopy,which has guiding value for anticoagulation and thrombosis prevention.关键词
血栓弹力图/个性化抗凝/膝关节镜/肌间静脉血栓Key words
thromboelastography(TEG)/personalized anticoagulation/knee arthroscopy/intermuscular venous throm-bosis分类
医药卫生引用本文复制引用
张中清,乔姝,吴麦拉苏,迟浩楠,王平平,孙金磊..血栓弹力图在膝关节镜手术预防下肢肌间静脉血栓中的应用[J].中国输血杂志,2024,37(6):625-631,7.基金项目
内蒙古自治区自然科学基金项目(2021MS08052) （2021MS08052）
内蒙古自治区卫生健康科技计划项目(202202236) （202202236）
包头医学院青年科技人才发展计划项目(BYJJ-DXK2022036) （BYJJ-DXK2022036）
