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目的探讨血栓弹力图(thrombelastography,TEG)对化疗后肺癌患者临床用血的指导作用。方法化疗后凝血功能异常需输血治疗的65例肺癌患者,随机分为TEG组29例和对照组36例,2组均于输血前和输血后24h检测凝血四项[包括凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,FIB)]和血小板计数(platelet count,PLT),TEG组同时行TEG检查。对照组采用凝血四项和血常规检查结果指导输血,TEG组采用TEG检查结果指导输血。比较2组输血前、后凝血四项和血常规指标,以及TEG组输血前、后TEG指标。结果 2组输血前PT、APTT、TT、FIB和PLT比较差异无统计学意义(P>0.05);TEG组输血后APTT[(32.51±6.27)s]、PT[(11.79±3.14)s]、TT[(19.28±3.18)s]低于输血前[(40.83±9.14)、(17.68±4.37)、(25.71±5.46)s](P<0.05),FIB[(2.91±0.93)g/L]和PLT[(125.41±53.78)×109/L]高于输血前[(1.35±0.48)g/L、(108.23±62.51)×109/L](P<0.05);对照组输血后APTT[(35.17±5.85)s]、PT[(13.62±3.54)s]、TT[(21.87±4.15)s]低于输血前[(41.52±8.65)、(17.24±4.81)、(25.13±4.35)s](P<0.05),FIB[(2.54±0.87)g/L]和PLT[(122.58±56.43)×109/L]高于输血前[(1.39±0.41)g/L、(113.72±61.83)×109/L](P<0.05);TEG组输血后PT、TT低于对照组(P<0.05),APTT、FIB和PLT与对照组比较差异无统计学意义(P>0.05);TEG组输血后凝血反应时间(R值)[(5.92±0.96)min]和凝血块形成时间(K值)[(3.07±0.81)min]低于输血前[(7.14±1.30)、(4.25±0.93)min](P<0.05),最大血凝块强度(MA值)[(56.84±10.27)mm]、血块形成速率(α角)[(65.23±12.96)°]和凝血综合指数(1.52±0.26)高于输血前[(45.37±9.62)mm、(54.72±11.53)°、-2.83±0.41](P<0.05);TEG组新鲜冰冻血浆[(136.27±41.32)mL]、冷沉淀[(3.24±1.35)u]输注量明显少于对照组[(164.13±47.35)mL、(4.57±1.62)u](P<0.05),血小板输注量[(4.76±2.47)u]与对照组[(5.61±2.83)u]比较差异无统计学意义(P>0.05)。结论与常规凝血功能检查相比,TEG检查能更好地指导化疗后肺癌患者各种血液成分的合理输注。
Objective To investigate the effect of thrombelastography (TEG) on the clinical use of blood in patients with lung cancer after chemotherapy. Methods Sixty-five patients with lung cancer who underwent transfusion therapy after chemotherapy were randomly divided into TEG group (n = 29) and control group (n = 36). Two groups were tested for blood clotting before transfusion and 24h after transfusion (including prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB) and platelet count (PLT) Group TEG inspection at the same time. In the control group, blood transfusion was guided by four blood coagulation tests and blood test results. TEG group used TEG test results to guide blood transfusion. The blood coagulation factors and blood coagulation indexes before and after blood transfusion were compared between the two groups, and the TEG indexes before and after blood transfusion in TEG group. Results There was no significant difference in PT, APTT, TT, FIB and PLT between the two groups before transfusion (P> 0.05). The levels of APTT, PT [(11.79 ± 3.14) s] TT [(19.28 ± 3.18) s] was lower than that before transfusion [(40.83 ± 9.14), (17.68 ± 4.37), (25.71 ± 5.46) s] And (125.41 ± 53.78) × 109 / L] were significantly higher than those before transfusion (1.35 ± 0.48 g / L, 108.23 ± 62.51 × 109 / L, P < 35.17 ± 5.85) s], PT [(13.62 ± 3.54) s] and TT [(21.87 ± 4.15) s] were lower than those before transfusion [(41.52 ± 8.65), (17.24 ± 4.81), (25.13 ± 4.35) s] (P <0.05), FIB [(2.54 ± 0.87) g / L] and PLT (122.58 ± 56.43) × 109 / L were higher than those before transfusions [(1.39 ± 0.41) g / L, (113.72 ± 61.83) × 109 / L] (P <0.05). The levels of PT and TT in the TEG group were lower than those in the control group (P <0.05), but there was no significant difference between the APTT, FIB and PLT groups The post-thrombolysis response time (R value [5.92 ± 0.96] min] and clot formation time (K value) [3.07 ± 0.81] min were lower than those before transfusion (7.14 ± 1.30, 4.25 ± 0.93) min ] (P <0.05), the maximal clot strength (MA value) [(56.84 ± 10.27) mm], the formation rate of the clot (α angle [65.23 ± 12.96] °] (1.52 ± 0.26) were higher than those before transfusions [(45.37 ± 9.62) mm, (54.72 ± 11.53) ° and -2.83 ± 0.41] respectively (P <0.05). The fresh frozen plasma in TEG group was (136.27 ± 41.32) mL The volume of transfusion of [(3.24 ± 1.35) u] was significantly less than that of the control group [(164.13 ± 47.35) mL, (4.57 ± 1.62) u] ] And control group [(5.61 ± 2.83) u] no significant difference (P> 0.05). Conclusion Compared with routine coagulation tests, TEG can better guide the rational infusion of various blood components in patients with lung cancer after chemotherapy.