目的 建立及评价血栓弹力图指导下脊柱侧凸矫正术中的输血方案.方法 2014年5月至2015年2月新疆医科大学第四附属医院共收治预计出血量＞1 000 ml的接受脊柱侧凸矫正术的患者60例,随机分为试验组(32例)和对照组(28例).试验组患者在血栓弹力图相关指标的指导下输血;对照组采用临床常规方法的输血方案.记录手术期间两组患者血液制品使用量,术后血小板计数、血红蛋白、血细胞比容及相关凝血常规指标,术中及术后24 h内失血量,住院天数、术后再出血率等.结果 两组患者年龄、体重、身高、手术时间差异均无统计学意义(P值均＞0.05).试验组和对照组的浓缩红细胞[(4.5±1.5)u和(7.1±l.2)u](t =4.343,P=0.001)、血小板[(2.5±1.3)u和(4.2±0.6)u](t =4.554,P=0.002)、新鲜冰冻血浆[(234±46) ml和(514±41)ml](t=3.723,P=0.004)、纤维蛋白原使用量[(2.4±0.6)g和(4.6±0.7)g](t =3.451,P=0.006)相比,差异均有统计学意义.两组术中出血量[(1 023±103) ml和(1 314±116) ml](t=2.260,P=0.120)、手术后再出血率(3.1％和3.6％)(x2 =0.340,P =0.450)、住院时间[(18±4)d和(16±6)d](t=2.140,P=0.160)的差异均无统计学意义.结论 与常规输血相比,脊柱侧凸矫正术应用血栓弹力图指导输血可以减少血液制品的使用量,但二者的安全性无差异.%Objective To systematically assess the benefits and harms of a thromboela-stogram (TEG) guided transfusion strategy with severe bleeding.Methods In this prospective study,60 patients scheduled for scoliosis were included in the Fourth Affilliated Hospital ,Xinjiang Medical University,from May 2014 to February 2014.Patients were allocated into either an TEG group or a standard management group.Results There was no significant difference in age, weight, height and operation time between the two groups (P ＞ 0.05).There were significant differences in red blood cell concentration ((4.5 ± 1.5)units and (7.1 ± 1.2) units) (t =4.343, P =0.001), platelet ((2.5 ± 1.3) units and (4.2 ± 0.6) units) (t =4.554, P =0.002) ,fresh frozen plasma ((234 ± 46) ml and (514 ± 41) ml) (t =3.723, P =0.004), fibrinogen ((2.4 ± 0.6) g and (4.6 ± 0.7) g) (t =3.451, P =0.006) between the TEG group and the standard management group.The two groups in intraoperative blood loss((1 023 ± 103) ml and (l 314 ± 116) ml) (t =2.260,P =0.120), incidence of rebleeding after operation (3.1％ and 3.6％) (x2 =0.340, P =0.450) ,hospitalization time ((18 ± 4) d and (16 ± 6) d) (t =2.140, P =0.160) had no statistically significant differences.Conclusion Application of a TEG guided transfusion strategy seems to reduce the amount of bleeding during correction operation of scoliosis.
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