Liu Yu, Zhang Wen-Li, Bu Ji-Qiang, Gu Jian-Jun, Sun Yong-Quan, Cui Hong-Zhan, Wang Da-Wei, Chen Zi-Ying
Department of Cardiac Surgery, Second Hospital of Hebei Medical University, Shi Jiazhuang, 050000, People's Republic of China.
Department of Cardiac Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, People's Republic of China.
Int J Gen Med. 2021 Mar 19;14:949-956. doi: 10.2147/IJGM.S291864. eCollection 2021.
This study aims to investigate the value of thromboelastography (TEG) in predicting blood loss, and its relationship with blood transfusion demand, during the perioperative period in off-pump coronary artery bypass grafting (OPCABG).
The data of 398 patients undergoing OPCABG were retrospectively analyzed. Blood was drawn before anesthesia induction (T1) and at 10 minutes after heparin neutralization (T2) for further TEG detection. The patients were divided into two groups based on the results at T2: a TEG normal group and a TEG abnormal group. Logistic regression analysis was used to predict the related factors contributing to the significant increase in perioperative blood loss (more than 20% of the estimated blood volume).
There were 277 (69.6%) patients in the TEG normal group and 121 (30.4%) in the TEG abnormal group. Compared with the TEG normal group, the volume of blood loss, red blood cell count, and volume of plasma transfusion in the TEG abnormal group significantly increased within 24 hours after surgery. The results of the logistic regression analysis identified the use of clopidogrel, platelet count at T2, fibrinogen level at T2, and abnormality in TEG value as independent predictors for the significant increase in perioperative blood loss ( < 0.001).
The abnormality in TEG value after heparin neutralization is correlated with massive hemorrhage and blood transfusion during the perioperative period in OPCABG. TEG detection can assist in clinical treatment and reduce the volume of blood lost in a hemorrhage and the volume of blood required in a transfusion during OPCABG.
本研究旨在探讨血栓弹力图（TEG）在非体外循环冠状动脉搭桥术（OPCABG）围手术期预测失血情况的价值及其与输血需求的关系。
回顾性分析398例行OPCABG患者的数据。在麻醉诱导前（T1）和肝素中和后10分钟（T2）采血进行TEG检测。根据T2时的结果将患者分为两组：TEG正常组和TEG异常组。采用逻辑回归分析预测导致围手术期失血显著增加（超过估计血容量的20%）的相关因素。
TEG正常组有277例（69.6%）患者，TEG异常组有121例（30.4%）患者。与TEG正常组相比，TEG异常组术后24小时内失血量、红细胞计数和血浆输血量显著增加。逻辑回归分析结果显示，使用氯吡格雷、T2时的血小板计数、T2时的纤维蛋白原水平以及TEG值异常是围手术期失血显著增加的独立预测因素（<0.001）。
肝素中和后TEG值异常与OPCABG围手术期大出血和输血相关。TEG检测有助于临床治疗，减少OPCABG术中失血量和输血量。
