Hawkins R B, Raymond S L, Hartjes T, Efron P A, Larson S D, Andreoni K A, Thomas E M
Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA; University of Florida College of Nursing, Gainesville, FL, USA.
Transplant Proc. 2018 Dec;50(10):3552-3558. doi: 10.1016/j.transproceed.2018.07.032. Epub 2018 Aug 9.
Thromboelastography (TEG) is a viscoelastic test that allows rapid evaluation of clot formation and fibrinolysis from a sample of whole blood. TEG is increasingly utilized to guide blood product resuscitation in surgical patients and transfusions for liver transplant patients. Patients with severe liver failure have significant derangement of their clotting function due to impaired production of procoagulant and anticoagulant factors. Traditional coagulation studies are limited by the short time needed for the result and provide little information about the dynamics and strength of clot formation. In addition, traditional coagulation studies do not correlate well with bleeding episodes and may lead to over-transfusion of various blood products. Evidence is less robust regarding the use of TEG for transfusion management decisions in severe liver failure patients awaiting, undergoing, or immediately after liver transplant surgery. However, the available evidence suggests that systematic implementation of TEG rather than traditional coagulation studies results in the administration of fewer blood products without increased mortality or complications. The purpose of this study is to review the literature regarding the use of TEG in liver failure patients prior to liver transplant, intraoperatively, and postoperatively. Additional high-quality randomized controlled studies should be performed to evaluate the use of TEG to guide transfusion decisions, particularly in the postoperative period following liver transplantation.
血栓弹力图（TEG）是一种粘弹性检测方法，可对全血样本的凝血形成和纤维蛋白溶解进行快速评估。TEG越来越多地用于指导外科手术患者的血液制品复苏以及肝移植患者的输血。严重肝功能衰竭患者由于促凝血因子和抗凝血因子生成受损，其凝血功能严重紊乱。传统凝血研究受限于得出结果所需的短时间，且提供的有关凝血形成动力学和强度的信息很少。此外，传统凝血研究与出血事件的相关性不佳，可能导致各种血液制品的过度输注。关于在等待、正在进行或刚做完肝移植手术的严重肝功能衰竭患者中使用TEG进行输血管理决策的证据尚不充分。然而，现有证据表明，系统实施TEG而非传统凝血研究可减少血液制品的使用，且不会增加死亡率或并发症。本研究的目的是回顾关于TEG在肝移植术前、术中及术后肝功能衰竭患者中应用的文献。应开展更多高质量的随机对照研究，以评估TEG在指导输血决策中的应用，尤其是在肝移植术后阶段。
