Kim Ji Young, Shin Yu Rim, Kil Hae Keum, Park Mi Ran, Lee Jong Wha
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Med Sci Monit. 2016 Oct 6;22:3576-3587. doi: 10.12659/msm.901256.
BACKGROUND Rotational thromboelastometry (ROTEM®) is a point-of-care test for coagulation, enabling physicians to make a swift decision. The aim of this investigation was to establish reference intervals of thromboelastometric evaluation for coagulation in pediatric patients with congenital heart diseases (CHD). MATERIAL AND METHODS As baseline data, 3 assays of ROTEM® (INTEM, EXTEM, and FIBTEM) were measured after anesthesia induction. ROTEM® parameters were clotting time (CT), amplitude at 10 min (A10), clot formation time (CFT), a angle, maximal clot firmness (MCF), clot lysis index at 60 min (LI60), and maximal clot elasticity (MCE). As age is a well-known factor for maturation, age groups were determined as follows; 1) <1 month, 2) 1-3 months, 3) 4-12 months, 4) 1-3 years, 5) 4-6 years, 6) 7-12 years, and 7) 13-16 years. Reference limits representing 95% of distribution of ROTEM® parameters and 90% confidence intervals of upper and lower reference limits were calculated. RESULTS The data of 413 patients were analyzed. Although INTEM CT was prolonged, significantly shorter CT and CFT, steeper α, and greater A10, MCF, and MCE were shown in patients age <3 months compared to older children. CONCLUSIONS Reference intervals of thromboelastometric evaluation for coagulation from pediatric patients with CHD were shown to have similar pattern to those obtained from healthy pediatric patients. Pediatric patients with CHD, even with cyanosis, were demonstrated to have functionally intact coagulation profile before surgery.
背景 旋转血栓弹力图（ROTEM®）是一种床旁凝血检测方法，可使医生迅速做出决策。本研究的目的是建立先天性心脏病（CHD）患儿凝血的血栓弹力图评估参考区间。材料与方法 作为基线数据，在麻醉诱导后测量3项ROTEM®检测指标（INTEM、EXTEM和FIBTEM）。ROTEM®参数包括凝血时间（CT）、10分钟时的振幅（A10）、凝血形成时间（CFT）、α角、最大凝血硬度（MCF）、60分钟时的凝血溶解指数（LI60）和最大凝血弹性（MCE）。由于年龄是成熟的一个众所周知的因素，年龄组确定如下：1）<1个月，2）1 - 3个月，3）4 - 12个月，4）1 - 3岁，5）4 - 6岁，6）7 - 12岁，7）13 - 16岁。计算代表ROTEM®参数分布95%的参考限值以及上下参考限值的90%置信区间。结果 分析了413例患者的数据。虽然INTEM CT延长，但与年龄较大的儿童相比，<3个月的患者显示出明显更短的CT和CFT、更陡的α角以及更大的A10、MCF和MCE。结论 CHD患儿凝血的血栓弹力图评估参考区间与健康小儿患者的参考区间具有相似模式。CHD患儿即使有青紫，术前凝血功能也显示正常。
