关键词:

肝硬化, 输血治疗, 血栓弹力图, 凝血四项

Abstract:

Objective　To explore the values of thromboelastography (TEG) versus four coagulation parameters in accurately guiding blood transfusion for patients with liver cirrhosis. Methods　This was a prospective study. One hundred and fifty-seven patients with liver cirrhosis who underwent blood transfusion at Xi'an International Medical Center Hospital from April 2022 to March 2024 were divided into a control group (78 cases) and an observation group (79 cases) by the random number table method. The control group had 42 males and 36 females who were (54.83±9.35) years old. The observation group had 44 males and 35 females who were (56.25±10.48) years old. The control group received blood transfusion guided by the results of four coagulation parameters, and the observation groups received blood transfusion guided by TEG indicators. The Pearson correlation analysis was used to evaluate the correlation between TEG indicators [reaction time (R), Angle angle, and maximum amplitude (MA)] and the four coagulation parameters [activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and fibrinogen (FIB)] before blood transfusion. The amounts of blood component transfusion, coagulation parameters before and after the treatment, occurrence of transfusion-related adverse reactions, hospital stays, and hospitalization costs were compared between the two groups. t and χ² tests were used for the statistical analysis. Results　The results of Pearson correlation analysis showed that R was positively correlated with APTT (r=0.473; P<0.001); Angle angle was negatively correlated with PT (r=-0.367; P<0.001) and APTT (r=-0.392; P<0.001), and positively correlated with FIB (r=0.571; P<0.001); MA was positively correlated with FIB (r=0.594; P<0.001). The infusion volumes of fresh frozen plasma, cold precipitate, red blood cell suspension, and platelet suspension in the observation group were (203.75±37.58) ml, (13.26±4.04) U, (3.43±1.29) U, and (1.48±0.28) U, respectively, which significantly lower than those in the control group [(287.37±46.72) ml, (17.54±3.76) U, (4.87±1.54) U, and (2.05±0.26) U], with statistical differences (t=8.580, 4.638, 5.133, 9.921; all P<0.05). Twenty-four hours after the treatment, the PT, APTT, and TT in the observation group were significantly lower than those in the control group [(14.01±4.33) s vs. (17.26±3.26) s, (34.28±4.74) s vs. (39.32±4.18) s, and (19.87±3.52) s vs. (23.71±3.74) s], while the FIB level was higher [(1.81±0.24) g/L vs. (1.53±0.17) g/L], with statistical differences (t=5.308, 7.063, 6.626, 8.426; all P<0.05). The incidence rate of transfusion adverse reactions in the observation group was lower than that in the control group [1.27% (1/79) vs. 10.26% (8/78)], with a statistical difference (χ²=4.325; P=0.038). The hospitalization time and expense in the observation group were lower than those in the control group [(9.08±2.87) d vs. (11.23±3.27) d and (51 700±10 500) yuan vs. (58 300±12 100) yuan], with statistical differences (both P<0.05). Conclusions　TEG indicators are correlated with the four coagulation parameters. Guiding blood transfusion for patients with liver cirrhosis based on TEG indicators can reduce the amount of blood component infusion and transfusion complications, improve their coagulation function, shorten the hospital stay, and decrease medical cost.

Key words:

Liver cirrhosis, Blood transfusion, Thromboelastography, Four coagulation parameters