旋转血栓弹力图引导下对一名患有海德氏综合征且正在接受经导管主动脉瓣植入术的患者进行围手术期凝血管理。
Rotational thromboelastometry-guided perioperative management of coagulation in a patient with Heyde's syndrome undergoing transcatheter aortic valve implantation.
作者信息
Fukuhara Kumi, Kondo Takashi, Miyoshi Hirotsugu, Hamada Hiroshi, Kawamoto Masashi
机构信息
Department of Anesthesiology and Critical Care, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
出版信息
JA Clin Rep. 2019 Jan 11;5(1):3. doi: 10.1186/s40981-019-0224-3.
BACKGROUND
Changes in coagulability during the hyperacute phase within 24 h after transcatheter aortic valve implantation (TAVI) for Heyde's syndrome, or aortic stenosis complicated by gastrointestinal angiodysplasia and acquired coagulation dysfunction, have not been clarified. We evaluated perioperative changes in coagulability using rotational thromboelastometry (ROTEM).
CASE PRESENTATION
A female patient with Heyde's syndrome in her 80s underwent TAVI. ROTEM showed coagulation dysfunction before and at 6 h after surgery. Improvements in coagulation function started at 12 h after surgery. Based on ROTEM findings, oral administration of antiplatelet agents was started on the day after surgery. No hemorrhagic complications were observed in the postoperative phase.
CONCLUSIONS
Evaluation of coagulation function using ROTEM was useful for monitoring perioperative hemostasis and coagulation in this patient.
背景
经导管主动脉瓣植入术（TAVI）治疗海德综合征（即主动脉瓣狭窄合并胃肠道血管发育异常及获得性凝血功能障碍）后24小时内超急性期的凝血变化尚不明确。我们使用旋转血栓弹力图（ROTEM）评估围手术期的凝血变化。
病例报告
一名80多岁的海德综合征女性患者接受了TAVI。ROTEM显示术前及术后6小时存在凝血功能障碍。术后12小时开始出现凝血功能改善。根据ROTEM结果，术后次日开始口服抗血小板药物。术后阶段未观察到出血并发症。
结论
使用ROTEM评估凝血功能有助于监测该患者围手术期的止血和凝血情况。
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