摘要
背景目前,针对肝硬化食管胃静脉曲张出血(esophagog-astric variceal bleeding,EVB)患者的典型临床表现为突发呕血和/或黑便,常伴有血流动力学不稳定,若未及时干预,可导致失血性休克、肝性脑病等多器官功能障碍,严重威胁患者生命.在内科药物治疗中,输血是重要环节,但目前尚缺乏肝硬化患者的输血规范.目的探讨血栓弹力图(thromboelastography,TEG)在指导EVB患者合理输血中的应用效果.方法前瞻性选取2023-06/2024-06义乌市中心医院收治的80例肝硬化EVB患者,随机分为对照组(40例,采用常规凝血功能指导输血)、试验组(40例,采用TEG指导输血).比较两组治疗成功率、血液制品使用量、患者凝血指标[血小板计数(platelet count,PLT)、血红蛋白(hemoglobin,Hb)含量、血细胞比容(hematocrit,HCT)、凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)]、并发症发生率及临床结局.结果两组治疗成功率比较(92.50%vs 82.50%),无显著差异(P>0.05);试验组红细胞悬浮液、血浆、血小板、冷沉淀使用量均低于对照组(P<0.05);输血后24 h,试验组PLT、Hb、HCT、FIB高于对照组,PT低于对照组(P<0.05);试验组电解质紊乱、肝性脑病、肝肾综合征、异位栓塞发生率与对照组比较,无显著差异(P>0.05);试验组大便转黄时间、气管插管时间、术后再出血率、死亡率及住院时间与对照组比较,差异均无统计学意义(P>0.05).结论TEG指导输血能在保证治疗效果的同时,减少血液制品使用量,改善患者凝血功能,且不增加并发症,不影响临床结局.
BACKGROUND The typical clinical manifestations of patients with liver cirrhosis esophageal variceal bleeding(EVB)are sudden hemesis and/or black stool,often accompanied by hemodynamic instability.If not intervened in time,it can lead to multiple organ dysfunction such as hemorrhatic shock and hepatic encephalopathy,seriously threatening the life of patients.Blood transfusion is a critical component of medical therapy,yet standardized guidelines for transfusion in cirrhotic patients are currently lacking.AIM To explore the application of thromboelastography(TEG)in guiding rational blood transfusion for patients with EVB due to liver cirrhosis.METHODS Eighty patients with liver cirrhosis and EVB admitted to Yiwu Central Hospital from June 2023 to June 2024 were prospectively selected and randomly divided into a control group(40 cases,guided by conventional coagulation function for blood transfusion)and an experimental group(40 cases,guided by TEG for blood transfusion).The treatment success rate,blood product usage,patient coagulation indicators[platelet count(PLT),hemoglobin(Hb)content,hematocrit(HCT),prothrombin time(PT),and fibrinogen(FIB)],the incidence of complication,and clinical outcomes were compared between the two groups.RESULTS There was no significant difference in the treatment success rate between the two groups(92.50%vs 82.50%,P>0.05).The amount of red blood cell suspension,plasma,platelets,and cryoprecipitate used in the experimental group was lower than that in the control group(P<0.05).At 24 h after blood transfusion,PLT,Hb,HCT and FIB in the experimental group were higher than those in the control group,and PT was lower than that in the control group(P<0.05).There was no significant difference in the incidence of electrolyte disturbance,hepatic encephalopathy,hepatorenal syndrome,or ectopic embolism between the two groups(P>0.05).There was no significant difference in the time to stool color change,duration of tracheal intubation,postoperative rebleeding rate,mortality,or hospitalization time between the two groups(P>0.05).CONCLUSION TEG-guided blood transfusion can reduce the use of blood products and improve the coagulation function of patients while ensuring the therapeutic effect,without increasing complications and affecting clinical outcomes.
作者
傅志成
陆小锋
Zhi-Cheng Fu;Xiao-Feng Lu(Department of Gastroenterology,Yiwu Central Hospital,Jinhua 32200,Zhejiang Province,China)
出处
《世界华人消化杂志》
2025年第10期797-804,共8页
World Chinese Journal of Digestology
基金
义乌市科学技术局科研计划项目,No.23-3-62.
关键词
血栓弹力图
肝硬化
食管胃静脉曲张出血
并发症
输血策略
Thromboelastography
Liver cirrhosis
Esopha-gogastric variceal bleeding
Complications
Blood transfusion strategy
