Preoperative evaluation and postoperative prediction of hemostatic function with thromboelastography in patients undergoing redo cardiac surgery.
Preoperative evaluation and postoperative prediction of hemostatic function with thromboelastography in patients undergoing redo cardiac surgery.
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DOI：
10.6955/aas.199812.0179
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发表时间：
1998-12
期刊：
影响因子：
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通讯作者：
Y. Cherng;Anne Chao;R. Shih;Chao-Shun Lin;Wei-Hung Chan;Chi-Hsiang Huang;Shen-Kou Tsai
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文献类型：
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作者：
Y. Cherng;Anne Chao;R. Shih;Chao-Shun Lin;Wei-Hung Chan;Chi-Hsiang Huang;Shen-Kou Tsai
背景：接受心脏手术的患者，特别是“重做”手术的患者，通常会出现大出血的并发症，主要是由于旁路诱导的凝血功能障碍。体外循环（CPB）可能导致血液成分在质量和数量上的损害。为了研究血液成分的质变，特别是由于先前心脏手术的复杂损伤引起的凝血，血栓弹性成像（TEG）用于分析整个凝血过程。方法对74例接受CPB心脏手术的患者进行前瞻性研究。其中32例患者接受了“重做”心脏手术。分别在体外循环术前和术后抽取血液进行常规实验室凝血试验（RCT）和TEG检查。术后前8小时，胸管引流连续3小时大于100 ml/h或1小时大于300 ml为临床显著性出血。比较术前和术后凝血参数，计算得出准确率、假阳性和假阴性率。结果在TEG示图中，与初始组相比，“重做”组术前α角和最大振幅显著降低，表明血小板功能和血小板-纤维蛋白相互作用减弱。在“重做”患者中，常规凝血试验也发现血小板计数较低。术后，“重做”组过度出血的比例也较高（42.8% vs.原发性组27.5%）。然而，与原发性心脏病患者相比，“重做”患者的预测准确性要低得多（53.5%对90%）。结论：血栓弹性成像不能预测“重做”心脏患者的术后出血，其图像记录不能作为输血治疗的指导。我们认为术前较差的止血状态和严重的凝血功能障碍可能是“重做”和原发性心脏病患者之间差异的原因。
BACKGROUND Patients who receive cardiac procedures, in particular "redo" ones, often suffer complications from massive bleeding, largely due to bypass-induced coagulopathies. Cardiopulmonary bypass (CPB) may cause damage of the blood components, both in terms of quality and quantity. In order to investigate the qualitative changes of blood constituents with special regard to coagulation resulting from the complex insult of previous cardiac surgery, thromboelastography (TEG) was used to analyze the whole clotting process. METHODS Seventy-four patients who underwent cardiac surgery with CPB were prospectively studied. Of them, 32 patients received "redo" cardiac surgery. Blood samples for routine laboratory coagulation tests (RCT) and TEG examination were drawn before and after cardiopulmonary bypass. Clinically significant bleeding was defined if the chest tube drainage was greater than 100 ml/h for 3 consecutive h or greater than 300 ml in 1 h during the first 8 h after surgery. Prebypass and postbypass coagulation parameters were compared and the percentage of accuracy, false positive and false negative rate were deduced from calculation. RESULTS In the TEG tracings, preoperative alpha angle and maximum amplitude were significantly decreased in the "redo" group when compared with primary group, indicating less competent platelet function and platelet-fibrin interaction. Lower platelet count was also found by conventional coagulation tests in "redo" patients. Postoperatively, higher percentage of excessive hemorrhage was also noted in the "redo" group (42.8% vs. 27.5% in primary group). However, a much lower predictive accuracy was found in "redo" patients in comparison with primary cardiac patients (53.5% vs. 90%). CONCLUSIONS We concluded that thromboelastography failed to predict postoperative hemorrhage in "redo" cardiac patients and the graphic recordings derived could not be treated as a guide of transfusion therapy. We thought that inferior preoperative hemostatic status and severer coagulopathy might be responsible for the differences between "redo" and primary cardiac patients.