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醫(yī)學(xué)拾萃 | 血栓彈力圖項(xiàng)目參數(shù)及臨床應(yīng)用


血栓彈力圖(thromboelastography,TEG)是1948年由德國人Hartert[1]發(fā)明的一種監(jiān)測(cè)凝血功能的新方法,動(dòng)態(tài)監(jiān)測(cè)從凝血因子激活到血小板-纖維蛋白血凝塊形成,再到血凝塊溶解的全過程,然后將血凝塊形成的速度和彈性強(qiáng)度轉(zhuǎn)化成直觀的曲線。


血栓彈力圖能夠評(píng)估凝固過程中凝血酶原酶的形成時(shí)間、纖維蛋白和凝血酶的生成速度、最終形成的凝血塊的彈力度和堅(jiān)固性、纖溶過程中纖維蛋白的溶解時(shí)間以及纖維蛋白的溶解速率,用R時(shí)間,K時(shí)間、α角、MA值、LY30等參數(shù)[2]反映凝血因子、血小板、纖維蛋白原以及纖溶系統(tǒng)(抗凝系統(tǒng))[3]的功能(參見表1)。



與常規(guī)檢測(cè)方法相比,血栓彈力圖更加快捷、精確,操作也更為方便,而且能整體觀察血液從開始凝固到血小板和纖維蛋白相互交織聚集形成穩(wěn)固的血凝塊,直至最后凝塊纖溶的整個(gè)動(dòng)態(tài)過程,是從整體角度上來評(píng)價(jià)凝血功能障礙的一個(gè)敏感性試驗(yàn),對(duì)出血性與血栓疾病具有一定診斷意義[4-5]。


目前血栓彈力圖已在多個(gè)國家的臨床中使用,常用于心腦血管疾病、圍術(shù)期、創(chuàng)傷救治、抗凝治療等領(lǐng)域[6-13]。


廣泛應(yīng)用于指導(dǎo)監(jiān)測(cè)術(shù)中輸血、監(jiān)測(cè)及糾正血液的高凝狀態(tài)、創(chuàng)傷性病人的救治、評(píng)估患者凝血全貌以及對(duì)于凝血機(jī)制的深度研究等多個(gè)方面[14-16]。


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參考文獻(xiàn)

[1]     Shore-Lesserson L, Manspeizer H E, DePerio M, et al. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesthesia&Analgesia, 1999, 88(2): 312-319.

[2]    Narani D. Thrombelastography in the perioperative period[J]. Indian Journal of Anaesthesia, 2005,49(2):89-95.

[3]    Lancé M D. A general review of major global coagulation assays: thrombelastography, thrombin generation test and clot waveform analysis[J]. Thrombosis journal, 2015, 13(1): 1.

[4]  Zongbao Liu, Erqing Chai, Hecheng Chen, et al. Comparison of Thrombelastography (TEG) in Patients with Acute Cerebral Hemorrhage and Cerebral Infarction. Medical Science Monitor.2018; 24: 6466–6471.

[5]  Zahr Eldeen F1, Roll GR, Derosas C, et al.Preoperative?thromboelastography?as a sensitive tool predicting those at risk of developing early hepatic artery?thrombosis?after adult liver transplantation. Transplantation. 2016, 100(11): 2382–2390.

[6]  da Luz L T, Nascimento B, Rizoli S. Thrombelastography(TEG®): practical considerations on its clinical use in trauma resuscitation. Scand J Trauma Resusc Emerg Med, 2013, 21:29.

[7]  Strauss T, Rozenzweig N, Rosenberg N, et al. Surfactant impairs coagulation in-vitro: A risk factor for pulmonary hemorrhage?. Thrombosis Research, 2013, 132(5):599-603.

[8]  Ustuner Z, Meltem Akay O, Keskin M, et al. Evaluating coagulation disorders in the use of bevacizumab for metastatic colorectal cancer by thrombelastography. Medical Oncology, 2012,29(5):3125-3128.

[9]  Sumann G, Kampfl A, Wenzel V, et al. Early intensive care unit intervention for trauma care: what alters the outcome? . Curr Opin Crit Care, 2002,8 (6):587-592.

[10]Armand R, Hess J R. Treating coagulopathy in trauma patients. Transfusion medicine reviews, 2003, 17(3): 223-231.

[11]Fries D, Innerhofer P, Streif W, et al. Coagulation monitoring and management of anticoagulation during cardiac assist device support[J]. The Annals of thoracic surgery, 2003, 76(5): 1593-1597.

[12]Ratel D, Glazier G, Proven}al M, et al. Direct-acting fibrinolytic enzymes in shark cartilage extract: potential therapeutic role in vascular disorders[J]. Thrombosis research, 2005, 115(1): 143-152.

[13]Cerutti E, Stratta C, Romagnoli R, et al. Thromboelastogram monitoring in the perioperative period of hepatectomy for adult living liver donation}J}. Liver transplantation, 2004, 10(2): 289-294.

[14]S.-C.Wang,J.-F.Shieh,K.-Y.Chang, et al. Thromboelastography-guided?transfusion?decreases?intraoperative blood transfusion?during orthotopic liver transplantation: randomized clinical trial. Transplantation Proceedings. 2010, 42(7):2590-2593.

[15]Walsh M, Thomas SG, Howard JC, et al. Blood Component Therapy in Trauma Guided with the Utilization of the Perfusionist and Thromboelastography. J Extra Corpor Technol. 2011, 43(3): 162–167.

[16]Bolliger D1, Seeberger MD, Tanaka KA. Principles and Practice of Thromboelastography in Clinical Coagulation Management and Transfusion Practice. Transfus Med Rev.2012, 26(1):1-13.

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