Study on the influence of coagulation test and thrombologram value on intraoperative nursing of patients with dissecting aneurysm
夹层动脉瘤患者凝血检查与血栓弹力图数值对术中护理影响研究

摘要

目的 探讨不同手术时机的主动脉夹层患者术前凝血检查和血栓弹力图（TEG）数值对术中护理的预测影响。方法 回顾性分析2023年2月至2023年6月期间在我院接受手术的87例主动脉夹层动脉瘤患者的临床资料。收集患者术前常规凝血和血常规检测结果，及肝素化前后5分钟内的中心静脉血TEG检测数据。根据手术时机将患者分为急诊手术组（观察组）和择期手术组（对照组）。对比分析两组患者的临床基本资料（性别、年龄、体重）、常规实验检测结果（射血分数、HB、HCT、PT、APTT、PLT）、体外循环时间、肝素化前后TEG数值、手术时长、住院天数、出血量、尿量、术中纱布使用量、术后24小时引流量等数据。通过分析TEG参数（R值、K值、α角、MA）与常规凝血实验检测（PT、APTT）、血常规（HB、PLT）之间的相关性，筛选出与术中护理和术后异常出血相关的因素。结果 1. 手术时机（急诊、择期）与性别存在显著差异，观察组（急诊）男性患者显著多于对照组（择期）（P=0.025）。2. 与对照组相比，观察组血红蛋白容积（HCT）减少1.26%（P<0.05），血红蛋白（HB）无显著差异，凝血酶原时间（PT）增加20.63%，活化部分凝血活酶时间（APTT）减少8.07%，血小板（PLT）减少19.67%。出血量增加21.8%，体外循环时间增加15.09%，血浆输注增加1.63%。结论 主动脉夹层动脉瘤患者的TEG数值与常规凝血实验检测及血小板数量之间存在明显相关性。TEG在夹层动脉瘤手术患者的凝血功能监测中具有重要作用，能迅速、准确地评估围手术期患者的凝血功能状态，并指导临床合理、有效的安全输血。明确患者的检测数值，可提高临床护理质量。

Abstract

Objective To investigate the predictive effect of preoperative coagulation test and TEG on intraoperative nursing in patients with aortic dissection at different time of operation.
Methods The clinical data of 87 patients with aortic dissection aneurysm who underwent surgery in our hospital from February 2023 to June 2023 were retrospectively analyzed. The results of preoperative routine coagulation and routine blood test, as well as central venous blood TEG test data within 5 minutes before and after heparinization were collected. According to the operation time, the patients were divided into emergency operation group (observation group) and elective operation group (control group). The basic clinical data (gender, age, weight), routine test results (ejection fraction, HB, HCT, PT, APTT, PLT), cardiopulmonary bypass time, TEG value before and after heparinization, operation duration, hospitalization days, blood loss, urine volume, intraoperative gauze usage, and postoperative drainage volume were compared and analyzed in the two groups. By analyzing the correlation between TEG parameters (R value, K value, α Angle, MA) and routine coagulation test (PT, APTT) and blood routine (HB, PLT), factors related to intraoperative nursing and postoperative abnormal bleeding were screened out.
Results 1. There were significant differences in the timing of surgery (emergency, elective) and gender. The male patients in the observation group (emergency) were significantly more than those in the control group (elective) (P=0.025). 2. Compared with the control group, the hemoglobin volume (HCT) of the observation group was decreased by 1.26% (P<0.05), hemoglobin (HB) was not significantly different, prothrombin time (PT) was increased by 20.63%, activated partial thromboplastin time (APTT) was decreased by 8.07%, and platelet (PLT) was decreased by 19.67%. Blood loss increased by 21.8%, cardiopulmonary bypass time increased by 15.09%, and plasma infusion increased by 1.63%.
Conclusion   There is a significant correlation between the TEG value of patients with aortic dissection aneurysm and the number of platelets detected by conventional coagulation test. TEG plays an important role in the monitoring of coagulation function in patients undergoing dissection aneurysm surgery, which can quickly and accurately evaluate the status of coagulation function in perioperative patients, and guide clinical rational, effective and safe blood transfusion. Clear detection value of patients can improve the quality of clinical nursing.