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血栓弹力描记术:放射科医师的综述及对围手术期出血风险的影响。

Thromboelastography: a review for radiologists and implications on periprocedural bleeding risk.

机构信息

University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.

Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA.

出版信息

Abdom Radiol (NY). 2022 Aug;47(8):2697-2703. doi: 10.1007/s00261-022-03539-9. Epub 2022 May 14.

Abstract

Thromboelastography (TEG) and rotational thromboelastometry are emerging technologies that are gaining increasing acceptance in the medical field to evaluate the coagulation status of patients on an individual level by assessing dynamic clot formation. TEG has been proven to reduce blood product use as well as improve patient outcomes in a variety of medical settings, including trauma and surgery due to the expediated nature of the test as well as the ability to determine specific deficiencies present in whole blood that are otherwise undetectable with traditional coagulation studies. Currently, no guidelines or recommendations are in place for the utilization of TEG in interventional or diagnostic radiology although access to TEG has become increasingly common in recent years. This manuscript presents a review of prior literature on the technical aspects of TEG as well as its use in various fields and explains the normal TEG-tracing parameters. Common hemodynamic abnormalities and their effect on the TEG tracing are illustrated, and the appropriate treatments for each abnormality are briefly mentioned. TEG has the potential to be a useful tool for determining the hemodynamic state of patients in both interventional and diagnostic radiology, and further research is needed to determine the value of these tests in the periprocedural setting.

摘要

血栓弹力描记术(TEG)和旋转血栓弹性描记术是新兴技术,它们通过评估动态血凝块形成,在个体水平上评估患者的凝血状态,在医学领域越来越受到认可。TEG 已被证明可减少血液制品的使用,并改善各种医疗环境(包括创伤和手术)中的患者预后,这归因于该检测的快速性质,以及能够确定全血中存在的特定缺陷,而这些缺陷是传统凝血研究无法检测到的。目前,虽然近年来 TEG 的应用已经越来越普遍,但在介入或诊断放射学中使用 TEG 还没有指南或建议。本文回顾了 TEG 的技术方面以及其在各个领域中的应用的相关文献,并解释了正常 TEG 描记参数。本文还说明了常见的血液动力学异常及其对 TEG 描记的影响,并简要提到了针对每种异常的适当治疗方法。TEG 有可能成为介入和诊断放射学中确定患者血液动力学状态的有用工具,需要进一步研究来确定这些检测在围手术期的价值。

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本文引用的文献

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The use of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in neonates: a systematic review.
Eur J Pediatr. 2021 Dec;180(12):3455-3470. doi: 10.1007/s00431-021-04154-4. Epub 2021 Jun 16.
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The Role of TEG Analysis in Patients with COVID-19-Associated Coagulopathy: A Systematic Review.
Diagnostics (Basel). 2021 Jan 26;11(2):172. doi: 10.3390/diagnostics11020172.
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Viscoelastic Blood Tests Use in Adult Cardiac Surgery: Meta-Analysis, Meta-Regression, and Trial Sequential Analysis.
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The Utility of Thromboelastography to Guide Blood Product Transfusion.
Am J Clin Pathol. 2019 Sep 9;152(4):407-422. doi: 10.1093/ajcp/aqz074.
10
Thromboelastography Predicts Thromboembolism in Critically Ill Coagulopathic Patients.
Crit Care Med. 2019 Jun;47(6):826-832. doi: 10.1097/CCM.0000000000003730.

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