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Improving safety: Neuraxial blockade guided by thromboelastography for patients with uncertain coagulation profile.提高安全性：针对凝血功能不确定的患者，采用血栓弹力描记术指导的脊神经阻滞。
J Postgrad Med. 2024 Jul 1;70(3):169-172. doi: 10.4103/jpgm.jpgm_361_24. Epub 2024 Aug 14.
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Utility of thromboelastography during neuraxial blockade in the parturient with thrombocytopenia.血小板减少产妇神经轴阻滞期间血栓弹力图的效用
AANA J. 2014 Apr;82(2):127-30.
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[Spinal and epidural anesthesia in patients with hemorrhagic diathesis : decisions on the brink of minimum evidence?].[出血素质患者的脊髓和硬膜外麻醉：基于最少证据的抉择？]
Anaesthesist. 2011 Dec;60(12):1126-34. doi: 10.1007/s00101-011-1930-z. Epub 2011 Jul 31.
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Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding.采用血栓弹力图（TEG）或血栓弹力测定法（ROTEM）监测成人或儿童出血患者的止血治疗效果并与常规治疗进行比较。
Cochrane Database Syst Rev. 2016 Aug 22;2016(8):CD007871. doi: 10.1002/14651858.CD007871.pub3.
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Thromboelastography (TEG®) demonstrates that tinzaparin 4500 international units has no detectable anticoagulant activity after caesarean section.血栓弹力图（TEG®）显示，剖宫产术后4500国际单位的替扎肝素无明显抗凝活性。
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Thromboelastography-guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: A systematic review and analysis.血栓弹力描记术指导治疗可改善择期心脏和肝脏手术及急诊复苏患者的血液管理和某些临床结局：系统评价与分析。
J Thromb Haemost. 2019 Jun;17(6):984-994. doi: 10.1111/jth.14447. Epub 2019 May 13.
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Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: Practice management guideline from the Eastern Association for the Surgery of Trauma.凝血功能障碍出血患者的血栓弹力描记术和旋转血栓弹力描记术：东部创伤外科学会的实践管理指南。
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Thromboelastography is a suboptimal test for determination of the underlying cause of bleeding associated with cardiopulmonary bypass and may not predict a hypercoagulable state.血栓弹力描记术是一种不理想的检测方法，无法确定与体外循环相关的出血的根本原因，也不能预测高凝状态。
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Perioperative Coagulation Profile with Thromboelastography in Aspirin-Treated Patients Undergoing Posterior Lumbar Fusion.阿司匹林治疗患者行后路腰椎融合术的围手术期血栓弹力描记术凝血特征。
Pain Physician. 2020 Nov;23(6):E619-E628.
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Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion.血栓弹力图（TEG）或血栓弹力测定法（ROTEM）用于监测大量输血患者的血液治疗与常规治疗。
Cochrane Database Syst Rev. 2011 Mar 16(3):CD007871. doi: 10.1002/14651858.CD007871.pub2.

本文引用的文献

1
Review of Thromboelastography (TEG): Medical and Surgical Applications.血栓弹力图（TEG）综述：医学及外科应用
Ther Adv Pulm Crit Care Med. 2023 Dec 14;18:29768675231208426. doi: 10.1177/29768675231208426. eCollection 2023 Jul-Dec.
2
Thromboelastography as a point-of-care guide for spinal anesthesia in an eclamptic patient: a case report.血栓弹力描记术指导子痫患者椎管内麻醉：病例报告。
Braz J Anesthesiol. 2021 May-Jun;71(3):278-280. doi: 10.1016/j.bjane.2020.10.011. Epub 2021 Feb 3.
3
Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH.产科粘弹性测试（血栓弹力图/旋转血栓弹力图）的系统评价及国际血栓与止血学会女性特别小组委员会的建议
J Thromb Haemost. 2020 Aug;18(8):1813-1838. doi: 10.1111/jth.14882.
4
Thromboelastography versus standard coagulation testing in the assessment and reversal of coagulopathy among cirrhotics: a systematic review and meta-analysis.血栓弹力描记术与标准凝血检测在肝硬化患者凝血障碍评估和逆转中的比较：系统评价和荟萃分析。
Eur J Gastroenterol Hepatol. 2020 Mar;32(3):291-302. doi: 10.1097/MEG.0000000000001588.
5
Use of Thromboelastography for Solving Neuraxial Blockade Dilemma.使用血栓弹力图解决神经轴阻滞困境。
Turk J Anaesthesiol Reanim. 2019 Aug;47(4):355-356. doi: 10.5152/TJAR.2019.05695. Epub 2019 Apr 24.
6
The Effect of Spinal versus General Anesthesia on Quality of Life in Women Undergoing Cesarean Delivery on Maternal Request.椎管内麻醉与全身麻醉对因产妇要求而行剖宫产的女性生活质量的影响。
Cureus. 2018 Dec 11;10(12):e3715. doi: 10.7759/cureus.3715.
7
The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine: Executive Summary 2015.《美国区域麻醉和疼痛医学学会关于区域麻醉和疼痛医学相关神经并发症的第二次实践咨询：2015年执行摘要》
Reg Anesth Pain Med. 2015 Sep-Oct;40(5):401-30. doi: 10.1097/AAP.0000000000000286.
8
Anesthesia for patients with liver disease.肝病患者的麻醉
Hepat Mon. 2014 Jul 1;14(7):e19881. doi: 10.5812/hepatmon.19881. eCollection 2014 Jul.
9
Utility of thromboelastography during neuraxial blockade in the parturient with thrombocytopenia.血小板减少产妇神经轴阻滞期间血栓弹力图的效用
AANA J. 2014 Apr;82(2):127-30.
10
Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials.硬膜外或脊髓麻醉降低术后死亡率和发病率：随机试验综述结果
BMJ. 2000 Dec 16;321(7275):1493. doi: 10.1136/bmj.321.7275.1493.

提高安全性：针对凝血功能不确定的患者，采用血栓弹力描记术指导的脊神经阻滞。

Improving safety: Neuraxial blockade guided by thromboelastography for patients with uncertain coagulation profile.

机构信息

Department of Anaesthesia, Medanta Hospital, Lucknow, Uttar Pradesh, India.

出版信息

J Postgrad Med. 2024 Jul 1;70(3):169-172. doi: 10.4103/jpgm.jpgm_361_24. Epub 2024 Aug 14.

DOI:10.4103/jpgm.jpgm_361_24
PMID:39140628
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11458078/
Abstract

Neuraxial blockade procedures are essential for anesthesia and pain management but pose risks in patients with uncertain coagulation profiles. Traditional coagulation tests often fail to predict bleeding risks associated with neuraxial blockade. Thromboelastography (TEG) offers real-time insights into coagulation status, potentially improving safety outcomes. In this case series, six patients underwent neuraxial blockade guided by TEG analysis. An individualized anesthetic plan was formulated based on TEG findings to mitigate bleeding risks while ensuring pain management. Tailoring anesthetic techniques to real-time TEG data improved safety outcomes with minimized bleeding complications and satisfactory pain control. In conclusion, neuraxial blockade guided by TEG enhances safety in patients with uncertain coagulation profiles. Further studies are needed to validate benefits in broader clinical settings.

摘要

神经轴阻滞程序对于麻醉和疼痛管理至关重要，但在凝血状况不确定的患者中存在风险。传统的凝血试验往往无法预测与神经轴阻滞相关的出血风险。血栓弹力图（TEG）可实时提供凝血状态的信息，从而提高安全性。在本病例系列中，6 名患者接受了 TEG 分析指导的神经轴阻滞。根据 TEG 结果制定个体化的麻醉计划，以降低出血风险，同时确保疼痛管理。根据实时 TEG 数据定制麻醉技术可改善安全性，减少出血并发症，同时获得满意的疼痛控制。总之，TEG 指导的神经轴阻滞可提高凝血状况不确定患者的安全性。需要进一步的研究来验证在更广泛的临床环境中的获益。