Bitkova E E, Zvereva N Iu, Khvatov V B, Chumakov M V, Timerbaev V Kh, Dublev A V, Redkoborodyĭ A V
Anesteziol Reanimatol. 2014 Jan-Feb(1):14-7.
To evaluate patients' hemostasis after cardiac surgery using thromboelastometric and impedance aggregometry.
66 patients were examined intraoperatively. Comparison group included 45 blood donors. Hemostasis was tested for thromboelastometricRotem Gamma with the assessment of external (exTem) and internal (inTem) pathways of coagulation tests performed detection of heparin (hepTem) and cytochalasin-D-inactivation of platelets (fibTem) to assess the level of fibrinogen. Collagen-induced platelet aggregation was determined in an aggregometer CHRONO-LOG (USA).
Significant deviations of the parameters of hemostasis were detected in 52 of the 66 studied patients. In group-1 (23 patients) revealed a residual effect of heparin. The effect manifested prolongation CT (clotting time) inTem to an average of 241 +/- 15 s, compared with CT hepTem--181 +/- 7. Patients in this group were in need of additional administration of protamine sulfate. Postoperative bleeding and resternotomia were observed in 3 patients of group-1. In group-2 (25 patients) CT inTem was 216 +/- 21 with significantly fewer CT hepTem (272 +/- 26). The data indicated excess of protamine sulfate. Platelets aggregation decreased compared to the norm. According to the obtained results, the addition of protamine sulfate is not required, however, in 7 cases the protamine sulfate was administered in a dose of 8.9 +/- 0.8 mg in 6 cases resternotomiya required. In the third group (n = 6) bleeding was observed in 4 patients. The difference in CT-hepCT was significant. Significant variations were revealed in the tests of the activity of the extrinsic pathway of coagulation and cytochalasin-D-induced inactivation of platelets: exMCF- 42 +/- 2 mm (normal 57 +/- 15 mm), fibMCF 5.0 +/- 0.3 mm (norm 12.8 +/- 4.3 mm). The concentration of platelets and their aggregation activity was sharply reduced. Disorders of hemostasis in the third group, designated as dilution coagulopathy.
Turning thromboelastometric and impedance aggregometry in the study of the coagulation profile of patients undergoing cardiac surgery in postperfusion period brings valuable information and allows a differentiated treatment of hemostasis disorders.
采用血栓弹力图和阻抗聚集法评估心脏手术后患者的止血情况。
术中对66例患者进行检查。对照组包括45名献血者。使用血栓弹力图Rotem Gamma检测止血情况，评估凝血的外部（exTem）和内部（inTem）途径，进行肝素检测（hepTem）和细胞松弛素-D诱导的血小板失活检测（fibTem）以评估纤维蛋白原水平。在美国CHRONO-LOG型聚集仪上测定胶原诱导的血小板聚集情况。
66例研究患者中有52例检测到止血参数存在显著偏差。在第1组（23例患者）中发现肝素存在残留效应。该效应表现为inTem的凝血时间（CT）延长至平均241±15秒，而hepTem的CT为18I±7秒。该组患者需要额外注射硫酸鱼精蛋白。第1组有3例患者出现术后出血和再次开胸。在第2组（25例患者）中，inTem的CT为216±21秒，而hepTem的CT明显更长（272±26秒）。数据表明硫酸鱼精蛋白过量。与正常情况相比，血小板聚集减少。根据所得结果，不需要添加硫酸鱼精蛋白，然而，有7例患者以8.9±0.8毫克的剂量注射了硫酸鱼精蛋白，其中6例需要再次开胸。在第3组（n = 6）中，4例患者出现出血。CT - hepCT的差异显著。在外源性凝血途径活性检测和细胞松弛素-D诱导的血小板失活检测中发现显著变化：exMCF为42±2毫米（正常为57±15毫米），fibMCF为5.0±0.3毫米（正常为12.8±4.3毫米）。血小板浓度及其聚集活性急剧降低。第3组的止血障碍被认定为稀释性凝血病。
在研究心脏手术患者灌注后期的凝血情况时，运用血栓弹力图和阻抗聚集法可提供有价值的信息，并有助于对止血障碍进行个体化治疗。
