血栓弹力图与活化凝血时间评价PCI术中普通肝素效果的比较研究

被引：10

作者：

侯旭敏

戴锦杰

韩文正

仇兴标

方唯一

机构：

[1] 上海交通大学附属胸科医院心内科

来源：

上海交通大学学报(医学版) | 2012年 / 32卷 / 11期

关键词：

经皮冠状动脉介入治疗; 血栓弹力图; 活化凝血时间; 普通肝素;

D O I：

暂无

中图分类号：

R541.4 [冠状动脉（粥样）硬化性心脏病（冠心病）];

学科分类号：

1002 ; 100201 ;

摘要：

目的采用血栓弹力图(TEG)和床旁活化凝血时间(ACT)方法,对择期经皮冠状动脉介入治疗(PCI)患者进行术前、术中以及术后凝血功能的测定,评价两种方法的敏感性和相关性。方法对36例稳定性冠心病拟行择期PCI术的患者,术前予以100 U/kg普通肝素(UFH)静脉注射。分别于PCI术前以及UFH注射后5 min和30 min检测患者外周静脉血ACT和TEG反应时间(TEG-R);并检测PCI术前及术后6、24、72 h的凝血功能指标(PT、APTT)和血常规指标(PLT、RBC、Hb)。结果 UFH注射后5 min,ACT和TEG-R均较基线水平明显延长,差异有统计学意义(P<0.001);UFH注射后30 min,ACT明显缩短(P<0.001),而TEG-R仍保持在较高水平(P>0.05)。PCI术后6 h,PT、APTT、RBC和Hb值均较基线水平有明显变化(P<0.05或P<0.001),但于术后24 h逐渐恢复至术前水平(P>0.05);PLT水平在上述各时间点均无明显变化(P>0.05)。相关性分析显示,TEG-R与ACT呈现高度曲线相关关系(P<0.001)。结论与ACT比较,TEG-R可以更敏感地检测出残余UFH量;提示TEG检测是评价PCI术中UFH效果敏感且有效的手段。

引用

页码：1486 / 1489+1500 +1500

页数：5

共 16 条

[1]

Parenteral anticoagulants:American college of chest physicians evidence-based clinical practice guidelines(8th Edition). Hirsh J,Bauer KA,Donati MB,et al. Chest . 2008

[2]

Thrombelastography. Mallett S V,Cox D J A. British Journal of Anaesthesia . 1992

[3] Role of Thrombolestagrophy in Monitoring Perioperative Coagulation Status and Effect of Thromboprophylaxis in Bariatric Surgery [J].

Forfori, Francesco ;

Ferro, Baldassare ;

Mancini, Biancamaria ;

Letizia, Ricci ;

Abramo, Antonio ;

Anselmino, Marco ;

Di Salvo, Claudio ;

Giunta, Francesco .

OBESITY SURGERY, 2012, 22 (01) :113-118

[4]

Effects of coagulation factor deficiency on plasma coagulation kinetics determined via Thrombelastography: critical roles of fibrinogen and FactorsⅡ,Ⅶ,ⅩandⅫ. Nielsen VG,Cohen BM,Cohen E. Acta Anaesthesiologica . 2005

[5]

The Relationship Among Thromboelastography, Hemostatic Variables, and Bleeding After Cardiopulmonary Bypass Surgery in Children[J] . Shyamala Moganasundram,Beverley J. Hunt,Kim Sykes,Fiona Holton,Kiran Parmar,Andrew Durward,Ian A. Murdoch,Conal Austin,David Anderson,Shane M. Tibby. &nbspAnesthesia & Analgesia . 2010 (4)

[6]

Detection of Protamine and Heparin After Termination of Cardiopulmonary Bypass by Thrombelastometry (ROTEM?): Results of a Pilot Study[J] . Markus Mittermayr,Corinna Velik-Salchner,Berndt Stalzer,Josef Margreiter,Anton Klingler,Werner Streif,Dietmar Fries,Petra Innerhofer. &nbspAnesthesia & Analgesia . 2009 (3)

[7]

The effects of un-fractionated heparin,low molecular weight heparin and danaparoid on the thrombelastogram(TEG):an in-vitro comparison of standard and heparinase-modified TEGs with conventional coagulation assays. Coppell J A,,Yhalheimer U,Zambruni A,et al. Blood Coagulation and Fibrinolysis . 2006

[8]

A novel thrombelastographytissue factor/kaolin assay activated clotting time for monitoringheparin anticoagulation during cardiopulmonary bypass. Chavez JJ,Foley DE,Snider CC,et al. Anesthesia and Analgesia . 2004

[9]

Heparin detection by the activated coagulation time: a comparison of the sensitivity of coagulation tests and heparin assays. Murray DJ,Brosnahan WJ,Pennell B,et al. Journal of Cardiothoracic and Vascular Anesthesia . 1997

[10]

Can thromboelastography performed on kaolin-activated citrated samples from critically ill patients provide stable and consistent parameters?. H White,C Zollinger,M Jones. Int J Lab Hematol . 2010

← 1 2 →