Vymazal Tomas, Astraverkhava Marta, Durila Miroslav
Department of Anesthesiology and Intensive Care Medicine, University Hospital Motol, 2nd School of Medicine, Charles University, Prague, Czech Republic.
Transfus Med Hemother. 2018 Nov;45(6):385-387. doi: 10.1159/000486453. Epub 2018 May 3.
Patients at intensive care units (ICUs) are often transfused to correct increased coagulation parameters (prothrombin time and activated partial thromboplastine time) and/or low platelet count. Thromboelastometry using whole blood is considered to be superior to these tests. In clinical praxis, prolonged standard tests are seen but thromboelastometry values are normal. The objective was to compare the blood product consumptions before and after the introduction of thromboelastometry assays into the treatment protocol during small surgical procedures at our mixed ICU.
We analyzed 1,879 patients treated at our ICU who underwent small interventions. We compared the fresh frozen plasma and platelet consumption before and after the introduction of rotational thromboelastometry into the routine use. The obtained data were compared to relevant research results from the PubMed database, the MeSH index in the Medline database, and Google Scholar using key words 'tromboelastometry', 'fresh frozen plasma' and 'platelets'.
Annual fresh frozen plasma and platelet consumptions were significantly decreased following thromboelastometry introduction. The number of patients and procedures did not differ significantly during the periods analyzed.
Routine thromboelastometry assays can enable significant reduction of blood product consumption in critically ill patients undergoing small surgery without any bleeding complications.
重症监护病房(ICU)的患者常接受输血以纠正凝血参数升高(凝血酶原时间和活化部分凝血活酶时间)和/或血小板计数过低。使用全血的血栓弹力图法被认为优于这些检测方法。在临床实践中,虽然标准检测结果延长,但血栓弹力图值却正常。目的是比较在我们的综合性ICU进行小手术时,将血栓弹力图检测引入治疗方案前后的血液制品消耗量。
我们分析了在我们ICU接受小手术的1879例患者。我们比较了将旋转血栓弹力图引入常规使用前后新鲜冰冻血浆和血小板的消耗量。使用关键词“血栓弹力图”、“新鲜冰冻血浆”和“血小板”,将获得的数据与来自PubMed数据库、Medline数据库中的医学主题词索引以及谷歌学术的相关研究结果进行比较。
引入血栓弹力图后,每年新鲜冰冻血浆和血小板的消耗量显著下降。在分析的时间段内,患者数量和手术数量没有显著差异。
常规血栓弹力图检测能够显著减少接受小手术的重症患者的血液制品消耗量,且无任何出血并发症。