肝硬化患者凝血功能障碍的评估：粘弹性检测效用的范围综述
Evaluation of coagulopathy in cirrhotic patients: A scoping review of the utility of viscoelastic testing.
作者信息
Azer Amanda, Kong Karen, Basta Daniel, Modica Stephen F, Gore Amy, Gorman Elizabeth, Sutherland Anne, Tafesh Zaid, Horng Helen, Glass Nina E
机构信息
Rutgers New Jersey Medical School, USA.
Hackensack University Medical School, USA.
出版信息
Am J Surg. 2024 Jan;227:34-43. doi: 10.1016/j.amjsurg.2023.09.001. Epub 2023 Sep 6.
BACKGROUND
Cirrhosis causes significant coagulopathy. Traditional coagulation tests may not accurately measure coagulopathy in well-compensated patients with cirrhosis. Viscoelastic tests are functional tests that may better assess coagulopathy in cirrhotic patients.
METHODS
We searched PubMed, ScienceDirect, Google Scholar, and grey literature using terms meaning viscoelastic testing and cirrhosis. After reviewing over 500 titles and abstracts, 40 full-text papers met inclusion criteria.
RESULTS
Twenty-two papers found viscoelastic testing was a better indicator of baseline coagulation than traditional testing in cirrhosis. Nineteen additional papers evaluated the utility of peri-procedural viscoelastic testing and found they led to a reduction in blood product administration without increasing risk of hemorrhage, thrombotic events, or other complications.
CONCLUSIONS
The usage of viscoelastic testing in patients with cirrhosis allows for better assessment of coagulopathy, resulting in improved outcomes. Educating physicians to optimize care of this high-risk group is necessary to further improve their treatment.
背景
肝硬化会导致严重的凝血病。传统凝血试验可能无法准确测量代偿良好的肝硬化患者的凝血病。黏弹性试验是一种功能试验，可能能更好地评估肝硬化患者的凝血病。
方法
我们使用与黏弹性检测和肝硬化相关的术语在PubMed、ScienceDirect、谷歌学术和灰色文献中进行搜索。在查阅了500多篇标题和摘要后，40篇全文论文符合纳入标准。
结果
22篇论文发现，在肝硬化患者中，黏弹性检测比传统检测更能准确反映基线凝血情况。另有19篇论文评估了围手术期黏弹性检测的效用，发现它们能减少血液制品的使用，且不会增加出血、血栓形成事件或其他并发症的风险。
结论
在肝硬化患者中使用黏弹性检测可以更好地评估凝血病，从而改善治疗结果。对医生进行培训以优化对这一高危群体的护理，对于进一步改善他们的治疗是必要的。
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