72例冠状动脉搭桥术围术期血栓弹力图变化分析

应用血栓弹力图(TEG)监测冠状动脉搭桥术患者围手术期凝血功能变化. 选择2011年1 月~2015年8月间收治并行冠状动脉搭桥手术治疗的患者72例, 根据手术方式分为非体外循环冠状动脉搭桥手术组(OPCAB组)45例, 体外循环冠状动脉搭桥术组(CABG组)27例, 2组患者均于术后12h开始用阿司匹林联合氯吡格雷抗血小板治疗, 并于术后24h进行TEG监测, 分析患者术前、术后24、96h的TEG变化情况. 研究结果表明: 术后24h OPCAB组较CABG组反应时间(R值)、血凝块形成时间(K值)降低, 最大振幅(MA值)、凝血指数(CI值)升高, 差异有统计学意义(P<0.05). 术后96h OPCAB与CABG组较各组术前R值、K值均降低, CI值均升高, 差异有统计学意义(P<0.05), 2组间各值差异无统计学意义(P>0.05). 从而得到CABG较OPCAB对患者凝血功能影响大, 呈现早期低凝, 晚期高凝的双向趋势, 原因可能与凝血因子消耗或缺乏以及体外循环全身肝素化有关. OPCAB手术对患者凝血功能影响较小, 术后呈现持续上升的高凝倾向. 因此建议对冠状动脉搭桥手术患者凝血功能进行检测, 术后可以选择性应用抗血小板药物或抗凝药物进行干预, 降低并发症发生, 对OPCAB术后患者可以给予更加积极的抗凝治疗.

Analysis of TEG changes on 72 cases of perioperative coronary artery bypass grafting

Applied thromboelastography (TEG) monitoring the changes of coagulation function during operation Abstract: Applied thromboelastography (TEG) monitoring the changes of coagulation function during operation in patients with coronary artery bypass grafting, providing the basis for coronary artery bypass operation treatment. A total number of 72 parallel cases of coronary artery bypass operation treatment from January 2011 to August 2015 were selected in our hospitals. According to the operation mode, those cases were divided into non extracorporeal circulation coronary artery bypass operation group (OPCAB group; 45 cases), extracorporeal circulation coronary artery bypass surgery group (CABG group; 27 cases). Both groups of patients were administered aspirin 12 hours following operation. TEG monitoring was used both prior to and following surgery. TEG changes were recorded prior to, 24 hours and 96 hours following operation. Compared with CABG group, OPCAB group showed significant decreases in R and K value and significant increases in MA and CI 24 hours after operation (P<0.05). Group CABG showed significantly decreased R and K and significantly increased MA and CI 96 hours after operation. No significant difference was found between two groups (P>0.05). Therefore, CABG has greater influence on the coagulation function of patients than OPCABG, which tended to be of hypocoagulability first and then hypercoagulability. Consumption or deficiency of coagulation factor and systemic heparin in extracorporeal circulation could be the main factor. OPCAB surgery has little effect on the coagulation function of patients, which tend to be of continuous hypercoagulability. It is of importance to detect the coagulation function in patients with coronary artery bypass surgery. Postoperative application of antiplatelet in given patients drug intervention could reduce complication and more aggressive anticoagulation after OPCAB.