Nuttall G A, Oliver W C, Ereth M H, Santrach P J
Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
J Cardiothorac Vasc Anesth. 1997 Dec;11(7):815-23. doi: 10.1016/s1053-0770(97)90112-9.
To determine the accuracy of coagulation profile laboratory tests, thromboelastography, and Sonoclot (SCT) values for predicting microvascular bleeding after cardiopulmonary bypass (CPB).
A prospective, blinded trial.
A large academic medical center.
Eighty-two adult patients undergoing elective cardiac surgery.
Ten minutes after CPB, thromboelastography, SCT, and coagulation profile tests (bleeding time, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin split products, platelet count, mean platelet volume, and platelet hematocrit) were determined from a whole blood sample taken from an existing arterial catheter. Patients were subjectively defined as "bleeders" or "non-bleeders" by blinded clinical observers. Preoperative baseline tests were also obtained.
Thirty of the 82 patients (36.6%) were characterized as bleeders. Coagulation profile tests had the best correlation with intraoperative and postoperative blood loss. The specificity, sensitivity, and negative and positive predictive values were determined by receiver operating characteristic analysis, and the test values that differentiated normal from abnormal (bleeding) patients were determined. The coagulation profile laboratory tests had the greatest maximal sensitivity and specificity for predicting bleeding. These predictive values were outside the normal range for these laboratory tests. The thromboelastography values that produced maximal sensitivity and specificity were in the normal range for that test.
Contrary to previous studies, coagulation profile tests had the greatest sensitivity and specificity to differentiate patients with excessive bleeding (abnormal) from those without excessive bleeding (normal) after CPB. Therefore, these tests should be used to guide transfusion therapy in patients who have excessive bleeding after CPB.
确定凝血指标实验室检测、血栓弹力图及Sonoclot（SCT）值预测体外循环（CPB）后微血管出血的准确性。
一项前瞻性、盲法试验。
一家大型学术医疗中心。
82例接受择期心脏手术的成年患者。
CPB后10分钟，从现有的动脉导管采集全血样本，测定血栓弹力图、SCT及凝血指标（出血时间、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、纤维蛋白降解产物、血小板计数、平均血小板体积及血小板压积）。由盲法临床观察者主观将患者定义为“出血者”或“非出血者”。还获取了术前基线检测结果。
82例患者中有30例（36.6%）被判定为出血者。凝血指标检测与术中和术后失血量的相关性最佳。通过受试者工作特征分析确定特异性、敏感性以及阴性和阳性预测值，并确定区分正常与异常（出血）患者的检测值。凝血指标实验室检测在预测出血方面具有最大的最大敏感性和特异性。这些预测值超出了这些实验室检测的正常范围。产生最大敏感性和特异性的血栓弹力图值在该检测的正常范围内。
与既往研究相反，凝血指标检测在区分CPB后出血过多（异常）患者与未出血过多（正常）患者方面具有最大的敏感性和特异性。因此，这些检测应用于指导CPB后出血过多患者的输血治疗。
