摘要
目的观察脑胶质瘤患者围手术期凝血功能状态异常发生情况,为胶质瘤患者术后出血及血栓风险相关并发症的预防提供依据。方法前瞻性收集首都医科大学附属北京天坛医院脑胶质瘤患者的术前信息和凝血检查结果、术中快速血栓弹力图(thromboelastogram,TEG)检测凝血功能结果和术后颅内出血、静脉栓塞的发生率。按照是否发生凝血功能异常相关并发症分组和组间比较,应用Logistic回归分析其相关危险因素。结果共纳入141例胶质瘤手术患者,发生凝血功能相关并发症28例,未发生者113例。术后发生凝血功能并发症组与未发生凝血功能并发症组比较,发生凝血功能并发症组的年龄较高[(47±17)岁∶(35±19)岁,P=0.003],术中胶体液使用更多(100%∶93%,P=0.014)、高级别胶质瘤患者比例更高(71%∶30%,P=0.003)、住院时间更长(19 d∶15 d,P=0.008)、围手术期脱水治疗天数更长(12.0 d∶10.5 d,P=0.017)。Logistic回归中,年龄[比值比(odds ratio,OR)=1.033,P=0.026]、高级别胶质瘤(OR=3.173,P=0.031)、术前凝血功能与术中TEG均异常(OR=4.332,P=0.028)、胶体液使用数量(OR=2.857,P=0.032)为发生术后凝血功能异常并发症的危险因素。结论脑胶质瘤患者术中肿瘤切除阶段应用快速TEG监测凝血功能结合术前标准凝血功能(standard coagulation tests,SCTs)结果,有助于识别术后凝血相关并发症的高危人群。
Objective To observe abnormal coagulation in glioma patients during perioperative period,and provide evidence for the prevention and control of postoperative hemorrhage and thrombosis risks related complications in glioma patients.Methods Prospective studies were performed using pre-operative information and coagulation results from glioma patients in Beijing Tiantan Hospital,Capital Medical University.Meanwhile,the coagulation function was detected by thromboelastogram(TEG).The incidences of intracranial hemorrhage and venous embolism after surgery were recorded.The patients with or without postoperative coagulation-related complications were compared.The risk factors were analyzed according to Logistic regression analysis.Results A total of 141 glioma patients treated by surgery were enrolled,including 28 patients with coagulation-related complications and 113 patients without the complications.Compared with patients without coagulation complications,those with post-operative complications had higher ages[(47±17)vs(35±19),P=0.003],increased volumes of colloid fluid used during surgery(100%vs 93%,P=0.014),increased proportion of advanced grade glioma(71%vs 30%,P=0.003),longer hospitalization stay(19 d vs 15 d,P=0.008)and longer duration of perioperative dehydration treatment(12.0 d vs 10.5 d,P=0.017).According to logistic regression analysis,age[odds ratio(OR)=1.033,P=0.026],high-grade glioma(OR=3.173,P=0.031),abnormal preoperative coagulation functions and perioperative TEG(OR=4.332,P=0.028),and the volume of colloid fluid used(OR=2.857,P=0.032)were the risk factors of postoperative coagulation complications.Conclusions A combination of rapid TEG monitoring of coagulation function during tumor resection and preoperative standard coagulation function(SCTs)is useful to identify patients with high risks of coagulation-related complications after surgery.
作者
闫翔
董佳
曾敏
彭宇明
Yan Xiang;Dong Jia;Zeng Min;Peng Yuming(Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《国际麻醉学与复苏杂志》
CAS
2019年第11期1030-1036,共7页
International Journal of Anesthesiology and Resuscitation
基金
北京市医院管理局重点医学专业发展计划(ZYLX201708)
北京市医院管理局"登峰"人才培养计划(DFL20180502)
首都卫生发展科研专项项目(2018-2-2044)。
关键词
脑肿瘤
围手术期
凝血功能障碍
Brain tumor
Perioperative period
Coagulation disorder
