Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Liver Transpl. 2012 Oct;18(10):1254-8. doi: 10.1002/lt.23494.
Plasma-containing products are given during the pre-anhepatic stage of liver transplant surgery to correct abnormal thromboelastogram (TEG) values and prevent blood loss due to coagulation defects. However, evidence suggests that abnormal TEG results do not always predict bleeding. We questioned what effect using higher TEG values to initiate treatment would have on blood loss. A single transfusion protocol was used for all patients who underwent liver transplantation between 2007 and 2010. Thirty-eight patients received coagulation products when standard TEG cutoff values were exceeded, whereas another 39 patients received coagulation products when the TEG values were 35% greater than normal. The results of postoperative coagulation tests for total blood loss and the use of blood products were compared for the 2 groups. When the critical TEG values for transfusion were higher, significantly fewer units of fresh frozen plasma (5.58 ± 6.49 versus 11.53 ± 6.66 U) and pheresis platelets (1.84 ± 1.33 versus 3.55 ± 1.43 U) were used. There were no differences in blood loss or postoperative blood product use. In conclusion, the use of higher critical TEG values to initiate the transfusion of plasma-containing products is not associated with increased blood loss. Further testing is necessary to identify what TEG value predicts bleeding due to a deficit in coagulation factors.
在肝移植手术的术前阶段，会给予含有血浆的产品，以纠正异常的血栓弹力图（TEG）值，并预防因凝血缺陷导致的失血。然而，有证据表明，异常的 TEG 结果并不总是能预测出血。我们想知道使用更高的 TEG 值来启动治疗会对失血产生什么影响。在 2007 年至 2010 年间，所有接受肝移植的患者都使用了单一的输血方案。38 名患者的 TEG 标准截断值超过时，会接受凝血产品治疗，而另外 39 名患者的 TEG 值比正常高出 35%时，也会接受凝血产品治疗。比较两组患者术后凝血检测的总失血量和血液制品使用情况。当输血的关键 TEG 值较高时，使用的新鲜冷冻血浆（5.58±6.49 与 11.53±6.66 U）和血小板单采术（1.84±1.33 与 3.55±1.43 U）单位显著减少。两组患者的失血量或术后血液制品使用情况无差异。总之，使用更高的关键 TEG 值来启动含血浆产品的输血与增加失血量无关。需要进一步的测试来确定哪种 TEG 值可以预测因凝血因子缺乏导致的出血。
