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使用旋转血栓弹力图（ROTEM）评估区域麻醉下胸腔内注射重组组织型纤溶酶原激活剂（rtPA）后的凝血状态。

Using Rotational Thromboelastometry (ROTEM) to Evaluate Coagulation Status After Intrapleural Recombinant Tissue Plasminogen Activator (rtPA) Administration in Regional Anesthesia.

作者信息

DeLeon Alexander, Tureanu Luminita, Vetter Olivia, Liu Tiffany, Korula Rechna, Garcia Tomas Vicente, Asher Yogen

机构信息

Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA.

出版信息

Cureus. 2024 Dec 11;16(12):e75547. doi: 10.7759/cureus.75547. eCollection 2024 Dec.

DOI:10.7759/cureus.75547
PMID:39664287
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11633844/
Abstract

We report a case of a 45-year-old male who underwent thoracotomy for empyema and received multiple doses of intrapleural recombinant tissue plasminogen activator (rtPA). Given the recent administration of rtPA, the acute pain service performed a rotational thromboelastometry (ROTEM) test to assess coagulation before proceeding with regional anesthesia. The ROTEM results indicated normal to hypercoagulable clotting parameters, with a normal extrinsic thromboelastometry (EXTEM) lysis index at 30 minutes, suggesting no systemic effects of rtPA. Based on these findings, a single-shot paravertebral block was successfully performed, and subsequent pain management included a thoracic epidural without complication or evidence of spinal hematoma. This case demonstrates that ROTEM can provide valuable reassurance on coagulation status in patients who have received intrapleural rtPA, helping to assess the safety of regional anesthesia.

摘要

我们报告一例45岁男性患者，该患者因脓胸接受了开胸手术，并接受了多剂胸膜腔内重组组织型纤溶酶原激活剂（rtPA）治疗。鉴于近期使用了rtPA，急性疼痛服务团队在进行区域麻醉前进行了旋转血栓弹力图（ROTEM）测试以评估凝血功能。ROTEM结果显示凝血参数正常至高凝状态，30分钟时外源性血栓弹力图（EXTEM）溶解指数正常，提示rtPA无全身影响。基于这些发现，成功实施了单次椎旁阻滞，随后的疼痛管理包括胸段硬膜外麻醉，未出现并发症或脊髓血肿迹象。该病例表明，ROTEM可为接受胸膜腔内rtPA治疗的患者的凝血状态提供有价值的保证，有助于评估区域麻醉的安全性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1ac/11633844/61de358a11a6/cureus-0016-00000075547-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1ac/11633844/6e26f4a82ff1/cureus-0016-00000075547-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1ac/11633844/61de358a11a6/cureus-0016-00000075547-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1ac/11633844/6e26f4a82ff1/cureus-0016-00000075547-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1ac/11633844/61de358a11a6/cureus-0016-00000075547-i02.jpg

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本文引用的文献

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Understanding the systemic effects of intrapleural tPA and DNase by evaluating effects on coagulation.通过评估对凝血的影响来了解胸膜腔内组织型纤溶酶原激活剂（tPA）和脱氧核糖核酸酶（DNase）的全身效应。
J Thorac Dis. 2024 Jan 30;16(1):91-98. doi: 10.21037/jtd-23-847. Epub 2024 Jan 16.
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Basic Principles of Rotational Thromboelastometry (ROTEM) and the Role of ROTEM-Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies.旋转血栓弹力图（ROTEM）的基本原理及ROTEM指导的纤维蛋白原替代疗法在凝血障碍管理中的作用
Diagnostics (Basel). 2023 Oct 16;13(20):3219. doi: 10.3390/diagnostics13203219.
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Serial EXTEM, FIBTEM, and tPA Rotational Thromboelastometry Observations in the Maastricht Intensive Care COVID Cohort-Persistence of Hypercoagulability and Hypofibrinolysis Despite Anticoagulation.
马斯特里赫特重症监护新冠队列中的连续EXTEM、FIBTEM和tPA旋转血栓弹力图观察——尽管进行了抗凝治疗，高凝状态和纤维蛋白溶解功能低下仍持续存在
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A systematic review on the rotational thrombelastometry (ROTEM®) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients.关于旋转血栓弹力图（ROTEM®）值在创伤患者凝血病诊断、输血预测与指导及死亡率预测方面的系统评价。
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Intrapleural therapy in management of complicated parapneumonic effusions and empyema.胸膜内治疗在复杂性类肺炎性胸腔积液和脓胸管理中的应用
Clin Pharmacol. 2010;2:213-21. doi: 10.2147/CPAA.S14104. Epub 2010 Nov 22.
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