Reinhöfer Mike, Brauer Martin, Franke Ulrich, Barz Dagmar, Marx Gernot, Lösche Wolfgang
Institute for Transfusion Medicine, Clinic for Anaesthesiology and Intensive Care Medicine, Division for Cardiothoracic Surgery, University Hospital Jena, Jena, Germany.
Blood Coagul Fibrinolysis. 2008 Apr;19(3):212-9. doi: 10.1097/MBC.0b013e3282f3f9d4.
Rotation thromboelastometry (ROTEM) performed on whole-blood samples provides information on the contribution of fibrinogen and platelets to clot formation. Such measurements are believed superior to classical plasma coagulation measurements as a means of monitoring disturbed haemostasis. On-pump cardiac surgery is associated with high bleeding risk. The study objective was to obtain information on the frequency of abnormal values of ROTEM variables and to assess their value in estimating bleeding risk in such patients. We studied 150 patients undergoing elective on-pump cardiac surgery. We found a significant surgery-induced decrease in haemostatic potential, with more abnormal ROTEM values in intrinsically activated coagulation (up to 50%) than in extrinsically activated coagulation (up to 27%) or the maximum clot firmness in FIBTEM (10%), a test measuring the contribution of fibrinogen. All ROTEM variables tend to normalize within 14-18 h postoperatively. Best positive predictive values and specificity for a postoperative blood loss above 600 ml were found for the clot formation time in extrinsically activated coagulation (71%/94%) and the maximum clot firmness in FIBTEM (73%/95%); these values were superior to the activated partial thromboplastin time or prothrombin time (56%/72% and 43%/5%, respectively). There was no relation between preoperative or early postoperative ROTEM values and intraoperative bleeding. ROTEM recorded a benefit of administration of platelet concentrates or fresh-frozen plasma, particularly when given postoperatively, on haemostasis. In contrast, intraoperative administration of red blood cells impaired haemostasis. ROTEM can provide a more detailed diagnostic basis enabling a focused therapy to cardiac surgery patients with high bleeding risk.
对全血样本进行旋转血栓弹力图（ROTEM）检测可提供有关纤维蛋白原和血小板对凝血形成贡献的信息。作为监测止血功能紊乱的一种手段，此类检测被认为优于传统的血浆凝血检测。体外循环心脏手术具有较高的出血风险。本研究的目的是获取ROTEM变量异常值的发生频率信息，并评估其在估计此类患者出血风险方面的价值。我们对150例行择期体外循环心脏手术的患者进行了研究。我们发现手术显著导致止血潜能下降，内源性激活凝血中ROTEM异常值更多（高达50%），高于外源性激活凝血（高达27%）或FIBTEM（一种测量纤维蛋白原贡献的检测）中的最大血凝块硬度（10%）。所有ROTEM变量在术后14 - 18小时内趋于正常化。对于术后失血超过600 ml，外源性激活凝血中的凝血形成时间（71%/94%）和FIBTEM中的最大血凝块硬度（73%/95%）具有最佳的阳性预测值和特异性；这些值优于活化部分凝血活酶时间或凝血酶原时间（分别为56%/72%和43%/5%）。术前或术后早期的ROTEM值与术中出血之间无关联。ROTEM记录了输注血小板浓缩物或新鲜冷冻血浆对止血的益处，尤其是术后输注时。相比之下，术中输注红细胞会损害止血功能。ROTEM可为出血风险高的心脏手术患者提供更详细的诊断依据，从而实现有针对性的治疗。
