Suzuki Shogo, Tamura Takahiro, Hasegawa Kazuko, Maeda Sho, Mori Reona, Kainuma Motoshi, Adachi Yushi, Nishiwaki Kimitoshi
Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Anesthesiology, Nagoya University Hospital, Nagoya, Japan.
Nagoya J Med Sci. 2019 May;81(2):259-267. doi: 10.18999/nagjms.81.2.259.
The activity of fibrinogen has been reported to decrease soon after the onset of major bleeding and to be an important determinant of the final extent of bleeding and postoperative outcome. A device that measures the perioperative fibrinogen level using the dry hematology (DH) method has recently become available. The aim of this study was to compare perioperative fibrinogen levels measured by the DH method with those measured by the conventional Clauss method and to assess the effects of heparin on these measurements. The study included 206 samples from 36 patients undergoing major surgery who received high-dose heparin (HH group, 23 samples), low-dose heparin (LH group, 57 samples), or no heparin (C group, 126 control samples). Each sample was measured using the DH and Clauss methods. After excluding samples outside the effective measurement range, the three study groups (HH group, n=23; LH group, n=49; C group, n=115) were compared. The mean fibrinogen level measured by the DH method in the HH group (87.9 ± 3.1%) was significantly lower than that measured by the Clauss method. There were no significant differences between the fibrinogen measurements obtained by the two methods between the LH and C groups. In patients on high-dose heparin, the mean fibrinogen level measured by the DH method was significantly lower than that measured by the Clauss method. When hemorrhage requires emergency treatment, a method that can measure the fibrinogen level rapidly is important. The DH method may be useful for decision-making with regard to perioperative coagulation factor replacement.
据报道,在大出血发作后不久,纤维蛋白原活性就会下降,并且是出血最终程度和术后结果的重要决定因素。一种使用干式血液学(DH)方法测量围手术期纤维蛋白原水平的设备最近已投入使用。本研究的目的是比较用DH方法测量的围手术期纤维蛋白原水平与用传统Clauss方法测量的水平,并评估肝素对这些测量结果的影响。该研究纳入了36例接受大手术患者的206份样本,这些患者接受高剂量肝素(HH组,23份样本)、低剂量肝素(LH组,57份样本)或未接受肝素(C组,126份对照样本)。每个样本均采用DH和Clauss方法进行测量。在排除有效测量范围之外的样本后,对三个研究组(HH组,n = 23;LH组,n = 49;C组,n = 115)进行比较。HH组中用DH方法测量的纤维蛋白原平均水平(87.9 ± 3.1%)显著低于用Clauss方法测量的水平。LH组和C组之间,两种方法测得的纤维蛋白原水平没有显著差异。在接受高剂量肝素治疗的患者中,用DH方法测量的纤维蛋白原平均水平显著低于用Clauss方法测量的水平。当出血需要紧急治疗时,一种能够快速测量纤维蛋白原水平的方法很重要。DH方法可能有助于围手术期凝血因子替代的决策。