Trzebicki Janusz, Kuzmińska Gabriela, Domagała Piotr
Medical University of Warsaw, Department of Anesthesiology and Intensive Care, Poland.
Pol Merkur Lekarski. 2009 Aug;27(158):85-91.
Thromboelastometry is a diagnostic method presenting in graphs and numbers the dynamics of hemostasis and physical properties of the clot forming. Thromboelastometry allows quick and complete assessment of clotting and fibrinolysis mechanism respecting share of coagulation and fibrinolytic factors and also platelets. Interpretation is based on comparative analysis of model data from computer memory with graphs and numeric data that present clot formation and fibrinolysis in time periods. Graphic presentation of quality and dynamics of coagulation process allow to understand its disorders caused for different reasons, like coagulation factors deficiency, thrombocytopenia, massive bleeding and transfusion or sometimes hypothermia. Measuring device used for thromboelastometry is mobile and makes possible to test blood by a patient bed. By introducing specialist reagents that activate clotting in vitro it is possible to shorten the diagnostic period to 15 minutes therefore multiple patient hemostasis controls can be achieved in real time. Quick diagnostic and possibility of assessment an influence of applied treatment on coagulation process allow to make proper therapeutic decisions in patients with coagulopathy. Hemostasis image and reference to clinical situation might be helpful in diagnosis if there is a surgical bleeding or there is a bleeding released by coagulation and fibrinolytic disorders. Thromboelastometry contributes not only to widen knowledge about complex mechanics of coagulation disorders but also to reduce usage of blood and its products. Thromboelastograhic examinations play a major role in the documentation of coagulation disorders treatment. In order to widen use of this method in clinical practice the algorithms are created, based on thromboelastometry and thromboelatograhy results. These can indicate type and quantity of blood products and medicines that are necessary to administer. Thromboelastometry is applied in many medical disciplines like cardiothoracic surgery, transplant surgery, obstetrics, multiorgan failures, vascular surgery and intensive care. In this method specialistic laboratory education is unnecessary.
血栓弹力图检测是一种诊断方法,它以图表和数字形式呈现止血动力学以及所形成凝块的物理特性。血栓弹力图检测能够快速、全面地评估凝血和纤溶机制,同时兼顾凝血因子、纤溶因子以及血小板的作用。其解读基于对计算机内存中模型数据与反映不同时间段内凝块形成和纤溶的图表及数值数据进行对比分析。凝血过程质量和动力学的图形展示有助于理解因不同原因导致的凝血障碍,如凝血因子缺乏、血小板减少、大量出血与输血情况,甚至有时还包括体温过低。用于血栓弹力图检测的测量设备便于移动,可在患者床边进行血液检测。通过引入能在体外激活凝血的专业试剂,可将诊断时间缩短至15分钟,从而能够实时对患者进行多次止血控制。快速诊断以及评估所应用治疗对凝血过程的影响,有助于为患有凝血病的患者做出恰当的治疗决策。如果存在手术出血或因凝血及纤溶障碍导致的出血情况,止血图像以及与临床情况的对照可能对诊断有所帮助。血栓弹力图检测不仅有助于拓宽对凝血障碍复杂机制的认识,还能减少血液及其制品的使用。血栓弹力图检查在凝血障碍治疗的记录中发挥着重要作用。为了在临床实践中更广泛地应用该方法,基于血栓弹力图检测和血栓弹力图检查结果创建了相关算法。这些算法能够指示所需输注的血液制品和药物的类型及数量。血栓弹力图检测应用于许多医学学科,如心胸外科、移植外科、产科、多器官功能衰竭、血管外科以及重症监护等领域。采用这种方法无需专业实验室培训。