Moriwaki K, Sato N, Kubota M, Maekawa T, Maekawa T, Nomura M, Sasaki H, Nakatani K, Yuge O
Department of Anesthesiology and Critical Care Medicine, School of Medicine, Hiroshima University.
Masui. 1992 Jul;41(7):1145-50.
Three patients with abnormal hemostasis during surgery were reported. They were monitored by thrombelastography (TEG). The first case was a 48 year old male who underwent extravivo hepatectomy. TEG showed hypo-coagulability during anhepatic phase. After reperfusion to the liver, the coagulability determined by TEG returned to a normal pattern. The second patient was a 32 year old female who underwent laparotomy to stop bleeding for cervico-vaginal laceration after delivery. The patient had been in severe hemorrhagic shock, and massive blood transfusion and fluid administration were performed. TEG showed remarkable hypocoagulability probably due to blood dilution and consumption coagulopathy. When TEG returned to a normal pattern after administration of fresh frozen plasma and fresh whole blood, the abnormal bleeding stopped. The third patient was a 48 year old male who underwent resection of metastatic brain tumor. He had hepatocellular carcinoma and liver cirrhosis. During surgery, abnormal bleeding was seen at surgical field, when TEG revealed remarkable hyper-fibrinolysis. After antifibrinolytic therapy coupled with replacement therapy, TEG returned to a normal pattern and the abnormal bleeding ceased. We conclude that TEG is a useful bed side monitor for the diagnosis of coagulopathy and hyper-fibrinolysis during surgery.
报告了3例手术期间止血异常的患者。他们接受了血栓弹力图（TEG）监测。第一例是一名48岁男性，接受了体外肝切除术。TEG显示无肝期凝血功能低下。肝脏再灌注后，TEG测定的凝血功能恢复正常模式。第二例患者是一名32岁女性，因产后宫颈阴道撕裂伤行剖腹探查止血术。患者处于严重失血性休克状态，进行了大量输血和补液。TEG显示明显的凝血功能低下，可能是由于血液稀释和消耗性凝血病所致。输注新鲜冰冻血浆和新鲜全血后TEG恢复正常模式时，异常出血停止。第三例患者是一名48岁男性，接受了转移性脑肿瘤切除术。他患有肝细胞癌和肝硬化。手术期间，手术野出现异常出血，此时TEG显示明显的高纤溶状态。抗纤溶治疗联合替代治疗后，TEG恢复正常模式，异常出血停止。我们得出结论，TEG是手术期间诊断凝血病和高纤溶状态的有用床边监测方法。
