查詢結果分析
來源資料
相關文獻
- Preoperative Evaluation and Postoperative Prediction of Hemostatic Function with Thromboelastography in Patients Undergoing Redo Cardiac Surgery
- 心臟手術中之凝血變化與手術期間之節血方法
- Effects of Thrombin on the Growth, Protein Synthesis, Attachment, Clustering and Alkaline Phosphatase Activity of Cultured Human Periodontal Ligament Fibroblasts
- 心臟手術病人居家期間克服壓力行為追蹤比較研究
- 淺談口服抗凝血劑 Warfarin 藥理及藥效特性
- 食物對口服抗凝血劑的影響
- 如何開始抗凝血治療
- Warfarin 之副作用
- 口服抗凝血劑之病患教育及病患服務
- 危機處理與抗凝血治療
頁籤選單縮合
題 名 | Preoperative Evaluation and Postoperative Prediction of Hemostatic Function with Thromboelastography in Patients Undergoing Redo Cardiac Surgery=二度心臟手術患者應用Thromboelastography評估手術前凝血功能以及預測手術後出血傾向 |
---|---|
作 者 | 程毅君; 趙安怡; 史若蘭; 林朝順; 詹偉弘; 黃啟祥; 蔡勝國; | 書刊名 | 麻醉學雜誌 |
卷 期 | 36:4 1998.12[民87.12] |
頁 次 | 頁179-186 |
分類號 | 416.5 |
關鍵詞 | 心臟手術; 凝血; Surgery ,cardiac; Blood coagulation; Thromboelastography; |
語 文 | 英文(English) |
中文摘要 | 背景:接受二度心臟手術的患者,常常會因爲廣泛的組織沾黏以及體外循環所引起的凝血功能異常,進而産生很嚴重的出血性併發症。體外循環對凝血成份所造成的傷害,不僅表現在數量的減少,在品質上亦會造成相當程度的變化。爲了探討前次體外循環所造成的傷害,我們應用thromboelastography來分析凝血功能的變化。方法:本研究選擇74位接受心臟手術的病人,其中有32人爲再次開心患者。兩組病患均在體外循環前後抽血,接受thromboelastography以及傳統凝血功能的檢查,以評估凝血功能有無異常並比較其間的差別。術後異常出血的定義爲胸管引流每小時超過100ml,連續3小時以上,或單一小時超過300ml。各項檢測均計算凖確度、爲陽率以及爲陰率。結果:手術前thromboelastography檢驗中的α角度、MA值,以及傳統凝血檢查中的血小板數量,在二度心臟手術患者,均有明顯的下降現象。手術後,接受二度心臟手術的病人,有較高比例的過度出血現象(42.8%對27.5%)。此外,對出血傾向之評估也明顯的低於對初次心臟手術患者之預測(53.5%對90%)。結論:實驗結果顯示,在二度心臟手術患者,thromboelastography無法凖確的預測手術後的出血傾向,也不能作爲輸血治療的指標。我們認爲手術前較差的凝血能力以及體外循環後較嚴重的凝血功能異常是造成與初次心臟手術患者間最大的差別。 |
英文摘要 | 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 mi/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 Ⅱ 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. |
本系統中英文摘要資訊取自各篇刊載內容。