Institute of Anesthesiology, University Hospital Zurich, Switzerland.
Minerva Anestesiol. 2010 Feb;76(2):131-7. Epub 2009 Nov 24.
Coagulopathy in surgical patients is an important factor in triggering major perioperative complications, i.e., intra- or postoperative bleeding and thrombo-embolic events associated with an increased mortality and morbidity. Different methods exist to assess the coagulation status of patients before, during and after surgery. Routine coagulation tests have long been considered to be the clinical standard. However, these tests have considerable limitations. Information regarding the kinetics of clot formation, clot strength, interaction of the coagulation components, platelet function and fibrinolysis is not available. Moreover, there is an important delay in obtaining test results. In contrast, thrombelastography and thrombelastometry, which both measure the visco-elastic properties of whole blood, allow the dynamic assessment of a developing clot, from fibrin formation to clot strengthening and clot lysis. Both techniques are increasingly being used in daily clinical practice in order to detect perioperative coagulopathy and to guide predominantly pro-coagulant therapy in different settings. This article provides an overview of both techniques, thrombelastography (TEG) and thrombelastometry (ROTEM), and their field of perioperative application considering of recently published data.
外科患者的凝血功能障碍是引发主要围手术期并发症的重要因素，例如手术期间或手术后的出血和血栓栓塞事件，这些并发症与死亡率和发病率增加有关。目前存在多种方法可以在手术前、手术中和手术后评估患者的凝血状态。常规凝血试验长期以来一直被认为是临床标准。然而，这些试验有很大的局限性。关于血栓形成动力学、血栓强度、凝血成分相互作用、血小板功能和纤维蛋白溶解的信息无法获得。此外，获得检测结果还存在重要的延迟。相比之下，血栓弹力描记术和血栓弹力图测量全血的粘弹性特性，允许从纤维蛋白形成到血栓强化和血栓溶解的动态评估正在形成的血栓。这两种技术在日常临床实践中越来越多地被用于检测围手术期凝血功能障碍，并指导不同情况下主要的促凝治疗。本文概述了这两种技术，血栓弹力描记术（TEG）和血栓弹力图（ROTEM），并考虑最近发表的数据概述了它们在围手术期的应用领域。
