医学拾萃 | 血栓弹力图项目参数及临床应用

2020-12-20 15:03| 编辑: 小桔灯网| 查看: 2375| 评论: 0|来源: 阳普医疗

摘要: 血栓弹力图（thromboelastography，TEG）是1948年由德国人Hartert发明的一种监测凝血功能的新方法，动态监测从凝血因子激活到血小板－纤维蛋白血凝块形成，再到血凝块溶解的全过程，然后将血凝块形成的速度和弹性强 ...

血栓弹力图（thromboelastography，TEG）是1948年由德国人Hartert^[1]发明的一种监测凝血功能的新方法，动态监测从凝血因子激活到血小板－纤维蛋白血凝块形成，再到血凝块溶解的全过程，然后将血凝块形成的速度和弹性强度转化成直观的曲线。

血栓弹力图能够评估凝固过程中凝血酶原酶的形成时间、纤维蛋白和凝血酶的生成速度、最终形成的凝血块的弹力度和坚固性、纤溶过程中纤维蛋白的溶解时间以及纤维蛋白的溶解速率，用R时间，K时间、α角、MA值、LY30等参数^[2]反映凝血因子、血小板、纤维蛋白原以及纤溶系统（抗凝系统）^[3]的功能（参见表1）。

与常规检测方法相比，血栓弹力图更加快捷、精确，操作也更为方便，而且能整体观察血液从开始凝固到血小板和纤维蛋白相互交织聚集形成稳固的血凝块，直至最后凝块纤溶的整个动态过程，是从整体角度上来评价凝血功能障碍的一个敏感性试验，对出血性与血栓疾病具有一定诊断意义^[4-5]。

目前血栓弹力图已在多个国家的临床中使用，常用于心脑血管疾病、围术期、创伤救治、抗凝治疗等领域^[6-13]。

广泛应用于指导监测术中输血、监测及纠正血液的高凝状态、创伤性病人的救治、评估患者凝血全貌以及对于凝血机制的深度研究等多个方面^[14-16]。

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参考文献

[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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