血栓弹力图评价关节置换术围手术期凝血功能改变
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Thromboelastography in assessment of blood coagulation function changes in perioperative patients undergoing arthroplasty
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    目的:利用血栓弹力图(thromboelastography,TEG)评价行髋膝关节置换术患者使用利伐沙班抗凝后的凝血功能改变,并分析与血小板计数的关系。方法:对2014年在我科行髋膝关节置换术的86例患者进行前瞻性研究。所有患者术后12 h开始使用10 mg利伐沙班抗凝治疗,并分别于术前、术后第1、3、5、7天行TEG及血小板计数检查。比较不同时间高凝患者比例及血小板计数的差异,并对二者进行相关性分析。结果:髋膝关节置换术后1~3 d及3~7 d高凝状态患者比例存在统计学差异,术后第7天高凝状态患者占86%,其中血小板高凝及混合性高凝患者占90.5%(maximal amplitude,MA>70 mm)。术后第3天患者血小板计数平均值较术前降低(P=0.063);而第3~7天血小板计数平均值逐渐增加,至第7天明显高于术前水平(P=0.000)。血小板计数与MA值呈正相关(r=0.508,P=0.000)。结论:TEG检测结果提示髋膝关节置换术后短时间使用利伐沙班不能有效降低高凝状态患者比例,且血小板数量的增加可能对高凝状态的形成发挥了重要作用。

    Abstract:

    Objective:To assess the coagulation status of patients undergoing arthroplasty after administration of rivaroxaban with thromboelastograph(TEG) in perioperative period,and to analyze the relation between coagulation status and blood platelet count. Methods:Eighty-six patients undergoing arthroplasty in our department in 2014 were included prospectively. All the patients were treated with 10 mg of rivaroxaban for 12 h after operation to prevent blood clots. TEG parameters and platelet count were analyzed simultaneously on the day before operation and on postoperative days 1,3,5 and 7. The proportion of hypercoagulability and mean platelet count were compared at different time points. And the correlation between hypercoagulable states and platelet count was per-formed with the use of correlation analysis. Results:There were significant changes in the distribution of different hypercoagulable states on days 1-3 and on days 3-7. Seven days after operation,86% patients were found with hypercoagulable state. Of these patients with hypercoagulable state,90.5% patients demonstrated platelet or mixed hypercoagulability(maximal amplitude(MA) values were greater than 70 mm). On day 3 after operation,the average amount of platelet count decreased slightly than that before opertation(P=0.063),but it were significantly higher(P=0.000) than the preoperative level on day 7 after operation. We also found positive correla-tion between MA and platelet count during the progress. Conclusion:TEG result indicates that the proportion of patients with hyper-coagulable state can not be reduced by a short time application of rivaroxaban. The increase of platelet count after operation may play an important role in the progress of blood hypercoagulability.

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简长春,陈 诚,戴浈浈,胡 宁,赵 辰,赵 智,廖军义,黄 伟.血栓弹力图评价关节置换术围手术期凝血功能改变[J].重庆医科大学学报,2015,(5):770-773

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  • 在线发布日期: 2015-11-04
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