摘要
目的 探讨血栓弹力图(TEG)预防脊柱外科静脉血栓栓塞症(VTE)高危患者围手术期并发症的价值.方法 收集2015年4月至2017年10月行脊柱外科手术的VTE高危(wells评分≥6)患者136例,按诊疗时间分为对照组64例和观察组72例,观察组患者均于手术当天(T0)、术后第1天(T1)、第3天(T2)、第5天(T3)及第7天(T4)清晨空腹静脉采血行普通TEG检测,并依据检测结果酌情给予抗凝治疗,应用低分子肝素针(克赛针)皮下注射抗凝治疗,至下地活动3d后停用,比较两组患者VTE的发生率、术后切口48h引流量和出血并发症发生率.结果 与术前相应TEG参数值比较,观察组患者术后TEG参数中R值和K值缩短(P=0.000),α角、MA、CI值增大(P<0.05).其中CI值在T2高于T3、T4,在术后第3天左右达到高峰.对照组术后VTE的发生率17.2%(11例),10例术后行下肢静脉超声检查发现下肢深静脉血栓形成,但无临床症状,另1例术后第4天因急性肺栓塞猝死;观察组VTE的发生率5.6%(4例),4例均为术后行下肢静脉超声检查发现无临床症状的下肢深静脉血栓形成,无严重并发症发生.对照组与观察组术后切口引流量的差异无统计意义(P>0.05),两组均未发生硬膜外血肿、神经损伤症状.结论 脊柱外科手术可导致血液的高凝状态,TEG是判断脊柱外科手术患者围手术期血液高凝状态的敏感指标.使用TEG动态监测脊柱外科患者术后血液高凝状态指导抗凝治疗能提高其有效性及安全性.
Objective To discuss the method and value of thrombelastogram(TEG)in prevention of perioperative complications in patients with high risk of venous thromboembolism(VTE)in spine surgery.Method 136 patients with high-VTE-risk(Well's Score≥6)who underwent spine surgeries from April 2015 to October 2017 were collected.The control group included 64 patients from April 2015 to June 2016,and the test group included 72 patients from July 2016 to October 2017.The venous blood of the patients of the test group on an empty stomach in the morning were collected for thrombelastogram before the operation(T0),the 1st day(T1),the 3rd day(T2),the 5th day(T3),and the 7th day(T4)after the operation separately.Anticoagulant therapy were given according to the test results and the patients requiring anticoagulation were given LMWH(4000IU)by subcutaneous injection.The occurrence rate of VTE,volume of drainage at 48h and hemorrhagic complications in both groups were observed.Result TEG of the test group showed that the R time and K time at T1 were significantly shorter than those at T0 respectively,while theαangle,MA and CI at T1 were significantly higher than those at T0 respectively.There were 11 VTE events(17.2%)in the control group during 2-week follow-up.Ten cases were found asymptomatic DVT by Doppler Ultrasound 7 days after surgery,and the other case suddenly died of pulmonary embolism 4 days after surgery.There were four patients suffered from VTE without symptom in the test group.The volumes of drainage at 48h of the two groups had no difference(P>0.05).Mucosal hemorrhage and neural injury symptoms were not discovered in both groups.Conclusion Spinal surgery can lead to blood hypercoagulability.Patients have hypercoagulabe states because of the spine surgery.TEG is a sensitive indicator for hypercoagulability during perioperative period of spine surgery.The efficacy and safety of anticoagulation therapy guided by TEG dynamic monitoring of blood hypercoagulability after spinal surgery can be improved.
出处
《浙江临床医学》
2019年第1期1-3,共3页
Zhejiang Clinical Medical Journal
基金
浙江省温州市科技局公益性科技计划项目(Y20160418).
