| 许寻,杨建业,秦磊磊,等.血栓弹力图预测髋膝关节置换术后血液高凝状态的价值分析.骨科,2020,11(3): 199-205. |
| 血栓弹力图预测髋膝关节置换术后血液高凝状态的价值分析 |
| Applied value of thromboelastography in predicting hypercoagulability after total hip and knee arthroplasty |
| 投稿时间：2020-01-11 |
| DOI：10.3969/j.issn.1674-8573.2020.03.004 |
| 中文关键词: 血栓弹力图 高凝状态 关节成型术，置换 危险因素 |
| 英文关键词: Thromboelastogram Hypercoagulable state Arthroplasty, replacement Risk factors |
| 基金项目: |
|
| 摘要点击次数: 4310 |
| 全文下载次数: 2465 |
| 中文摘要: |
| 目的 分析血栓弹力图（thromboelastography, TEG）预测髋膝关节置换术后病人血液高凝状态的价值。方法 前瞻性纳入2019年3月至2019年12月于重庆医科大学附属第一医院拟行髋膝关节置换的204例病人，分析病人围术期的反应时间（R值）、血块形成时间（K值）、血块形成速率（α角）、最大振幅（MA值）、凝血指数（CI）的变化，评估TEG在诊断高凝状态方面与常规凝血试验的差异性和一致性，分析术后血液高凝的危险因素。结果 相对于常规凝血试验，TEG诊断高凝状态的阳性率更高（P<0.001），两者具有一定的相关性和一致性。R值与国际标准化比值（international normalized radio, INR）、血小板计数（platelet counts, PLT）呈负相关，与活化部分凝血酶原时间（activated partial thromboplastin time, APTT）呈正相关；K值与PLT呈负性相关；α角与纤维蛋白原（fibrinogen, FIB）、PLT呈正相关；MA值与FIB、PLT呈正相关；CI值与FIB、PLT呈正相关，与D-二聚体（D-Dimer, D-D）呈负相关。术前高凝病人术后第1、3、5天的血液高凝发生率明显高于术前凝血功能正常者，差异均有统计学意义（P均<0.05）。根据术后第5天TEG诊断的凝血状态，年龄≥65岁［OR=8.938，95% CI（3.917，20.397），P<0.001］、围术期输血［OR=12.379，95% CI（5.304，28.893），P<0.001］是髋膝关节置换术后血液高凝的独立危险因素。结论 TEG是预测术后高凝的有效指标，对于指导髋膝关节置换围术期个体化抗凝具有重要意义。 |
| 英文摘要: |
| Objective To analyze the applied value of thromboelastography (TEG) in predicting hypercoagulability of patients after hip and knee replacement. Methods 204 patients undergoing hip and knee replacement were prospectively included from March 2019 to December 2019. The changes of TEG-related indexes such as R value, K value, α angle, MA value and CI value during the perioperative period were analyzed. The difference and consistency of TEG were evaluated in diagnosing hypercoagulable state from routine coagulation tests. The risk factors for postoperative blood hypercoagulation were analyzed. Results The positive rate of TEG diagnosis of hypercoagulable state was significantly higher that the conventional coagulation test (P<0.001), and the two tests had a certain correlation and consistency. R value was negatively correlated with INR and PLT and positively correlated with APTT. K value was negatively correlated with PLT. α angle was positively correlated with FIB and PLT. MA value was positively correlated with FIB and PLT. CI value was positively correlated with FIB and PLT, and negatively correlated with DD. The preoperative hypercoagulation patients had a significantly higher incidence of hypercoagulation at 1st, 3rd, and 5th day after surgery than those with normal precoagulation, and the differences were statistically significant (all P<0.05). According to the coagulation status diagnosed by TEG on the 5th postoperative day, age ≥65 years ［OR=8.938, 95% CI (3.917, 20.397), P<0.001］ and perioperative blood transfusion ［OR=12.379, 95% CI (5.304, 28.893), P<0.001］ were independent risk factors for hypercoagulability after hip and knee replacement. Conclusion TEG is an effective indicator for predicting postoperative hypercoagulability, and is of great significance to guide the individualized anticoagulation of hip and knee replacements during the perioperative period. |
|
查看全文
下载PDF阅读器 |
| 关闭 |
|
|
|
