Schulick Alexander C, Moore Hunter B, Walker Carson B, Yaffe Hillary, Pomposelli James J, Azam Fareed, Wachs Michael, Bak Thomas, Kennealey Peter, Conzen Kendra, Adams Megan, Pshak Thomas, Choudhury Rashikh, Chapman Michael P, Pomfret Elizabeth A, Nydam Trevor L
Department of Surgery, Division of Transplant Surgery, University of Colorado, United States.
Department of Surgery, Division of Transplant Surgery, University of Colorado, United States.
Am J Surg. 2020 Dec;220(6):1379-1386. doi: 10.1016/j.amjsurg.2020.07.034. Epub 2020 Sep 1.
An NIH clinical coagulopathy score has been devised for trauma patients, but no such clinical score exists in transplantation surgery. We hypothesize that that this coagulopathy score can effectively identify laboratory defined coagulopathy during liver transplantation and correlates to blood product utilization.
TEGs were performed and coagulopathy scores (1, normal bleeding - 5, diffuse coagulopathic bleeding) were assigned by the surgeons at 5 intra-operative time points. Blood products used during the case were recorded between time points. Statistical analyses were performed to identify correlations between coagulopathy scores, TEG-detected abnormalities, and blood product utilization.
Transfusions rarely correlated with the appropriate TEG measurements of coagulation dysfunction. Coagulopathy score had significant correlation to various transfusions and TEG-detected coagulopathies at multiple points during the case. High aggregate coagulopathy scores identified patients receiving more transfusions, re-operations, and longer hospital stays CONCLUSION: The combination of viscoelastic testing and a standardized clinical coagulopathy score has the potential to optimize transfusions if used in tandem as well as standardize communication between surgery and anesthesia teams about clinically evident coagulopathy.
美国国立卫生研究院（NIH）已为创伤患者设计了临床凝血病评分，但移植手术中尚无此类临床评分。我们假设该凝血病评分能够有效识别肝移植期间实验室定义的凝血病，并与血液制品的使用相关。
在5个术中时间点进行血栓弹力图（TEG）检测，并由外科医生指定凝血病评分（1，正常出血 - 5，弥漫性凝血病性出血）。记录病例期间各时间点使用的血液制品。进行统计分析以确定凝血病评分、TEG检测到的异常与血液制品使用之间的相关性。
输血与凝血功能障碍的适当TEG测量结果很少相关。凝血病评分与病例期间多个时间点的各种输血及TEG检测到的凝血病显著相关。高凝血病综合评分表明患者接受了更多输血、再次手术且住院时间更长。结论：如果联合使用，粘弹性检测和标准化临床凝血病评分有可能优化输血，并使手术和麻醉团队之间关于临床明显凝血病的沟通标准化。
