Weber C F, Sanders J O, Friedrich K, Gerlach R, Platz J, Miesbach W, Hanke A A, Hofstetter C
Klinik für Anästhesiologie, Intensivmedizin u. Schmerztherapie, Klinikum der J.-W.-Goethe-Universität Theodor-Stern-Kai 7, 60590 Frankfurt am Main.
Hamostaseologie. 2011 May 2;31(2):111-7. doi: 10.5482/ha-1132. Epub 2010 Dec 9.
Recently published studies give evidence, that an increased maximum lysis in the APTEM® - test (ML60 > 12%) of the ROTEM® (Tem International GmbH, Munich, Germany) might indicate a factor XIII deficiency (FXIII < 70%). It was the aim of this study to investigate the feasibility of thrombelastometric measurements with the ROTEM device to reflect the isolated influence of FXIII on clot stability and therefore to indicate potential factor XIII deficiencies.
PATIENTS, METHOD: After approval by the local Scientific and Ethic Review Board, 26 consecutive patients, scheduled for elective craniotomy for tumour resection, were prospectively enrolled into this study. Blood samples were taken for conventional laboratory coagulation analyses, FXIII analyses and thrombelastometric measurements (EXTEM, FIBTEM and APTEM tests) after induction of general anaesthesia (T1), before skin incision (T2) as well as at (T3) and 24 hours after (T4) postoperative admission to ICU, respectively. Statistical analyses included Spearman rank order correlations and multiple linear regressions.
FXIII concentrations did not correlate with the ML60 in the APTEM test at any measuring point. Neither platelet count nor fibrinogen nor FXIII concentrations were of predictive value for ML60 of the APTEM test.
The results lead to the assumption that thrombelastometric measurements may not be appropriate for the perioperative monitoring of FXIII concentration.
最近发表的研究表明，在ROTEM®（德国慕尼黑的Tem International GmbH公司）的APTEM®检测中（ML60>12%）最大溶解增加可能提示因子 XIII 缺乏（FXIII<70%）。本研究的目的是探讨使用ROTEM设备进行血栓弹力图测量以反映因子 XIII 对血凝块稳定性的单独影响并因此提示潜在因子 XIII 缺乏的可行性。
患者、方法：经当地科学与伦理审查委员会批准，连续纳入26例计划择期行肿瘤切除开颅手术的患者。分别在全身麻醉诱导后（T1）、皮肤切开前（T2）以及术后入住重症监护病房时（T3）和术后24小时（T4）采集血样进行常规实验室凝血分析、因子 XIII 分析和血栓弹力图测量（EXTEM、FIBTEM和APTEM检测）。统计分析包括Spearman等级相关性和多元线性回归。
在任何测量点，因子 XIII 浓度与APTEM检测中的ML60均无相关性。血小板计数、纤维蛋白原和因子 XIII 浓度对APTEM检测的ML60均无预测价值。
结果提示血栓弹力图测量可能不适用于围手术期因子 XIII 浓度的监测。
