血栓弹力图预防脊柱外科患者围手术期并发症的价值

摘要

目的 探讨血栓弹力图(TEG)预防脊柱外科静脉血栓栓塞症(VTE)高危患者围手术期并发症的价值.方法 收集2015年4月至2017年10月行脊柱外科手术的VTE高危(wells评分≥6)患者136例,按诊疗时间分为对照组64例和观察组72例,观察组患者均于手术当天(T0)、术后第1天(T1)、第3天(T2)、第5天(T3)及第7天(T4)清晨空腹静脉采血行普通TEG检测,并依据检测结果酌情给予抗凝治疗,应用低分子肝素针(克赛针)皮下注射抗凝治疗,至下地活动3d后停用,比较两组患者VTE的发生率、术后切口48h引流量和出血并发症发生率.结果 与术前相应TEG参数值比较,观察组患者术后TEG参数中R值和K值缩短(P=0.000),α角、MA、CI值增大(P0.05),两组均未发生硬膜外血肿、神经损伤症状.结论 脊柱外科手术可导致血液的高凝状态,TEG是判断脊柱外科手术患者围手术期血液高凝状态的敏感指标.使用TEG动态监测脊柱外科患者术后血液高凝状态指导抗凝治疗能提高其有效性及安全性.%Objective To?discuss?the?method?and?value?of?thrombelastogram(TEG)in?prevention?of?perioperative?complications?in?patients?with?high?risk?of?venous?thromboembolism(VTE)in?spine?surgery.?Method? 136?patients?with?high-VTE-risk(Well's?Score≥6)who?underwent?spine?surgeries?from?April?2015?to?October?2017?were?collected.?The?control?group?included?64?patients?from?April?2015?to?June?2016,and?the?test?group?included?72?patients?from?July?2016?to?October?2017.The?venous?blood?of?the?patients?of?the?test?group?on?an?empty?stomach?in?the?morning?were?collected?for?thrombelastogram?before?the?operation(T0),the?1st?day(T1),the?3rd?day(T2),the?5th?day(T3),and?the?7th?day(T4) after?the?operation?separately.?Anticoagulant?therapy?were?given?according?to?the?test?results?and?the?patients?requiring?anticoagulation?were?given?LMWH (4000IU)by?subcutaneous?injection.?The?occurrence?rate?of?VTE,volume?of?drainage?at?48h?and?hemorrhagic?complications?in?both?groups?were?observed.?Result? TEG?of?the?test?group?showed?that?the?R?time?and?K?time?at?T1?were?significantly?shorter?than?those?at?T0?respectively,while?the?α?angle,MA?and?CI?at?T1?were?significantly?higher?than?those?at?T0?respectively.There?were?11?VTE?events(17.2%)in?the?control?group?during?2-week?follow-up.Ten?cases?were?found?asymptomatic?DVT?by?Doppler?Ultrasound?7?days?after?surgery,and?the?other?case?suddenly?died?of?pulmonary?embolism?4?days?after?surgery.There?were?four?patients?suffered?from?VTE?without?symptom?in?the?test?group.The?volumes?of?drainage?at?48h?of?the?two?groups?had?no?difference(P>0.05).Mucosal?hemorrhage?and?neural?injury?symptoms?were?not?discovered?in?both?groups.?Conclusion? Spinal?surgery?can?lead?to?blood?hypercoagulability.Patients?have?hypercoagulabe?states?because?of?the?spine?surgery.?TEG?is?a?sensitive?indicator?for?hypercoagulability?during?perioperative?period?of?spine?surgery.?The?efficacy?and?safety?of?anticoagulation?therapy?guided?by?TEG?dynamic?monitoring?of?blood?hypercoagulability?after?spinal?surgery?can?be?improved.