标题：血栓弹力图与FIB联合预测普外科患者围术期大量输血的效能评价

      作者：邵方真 1，闫优萍 1，朱俊 2，常圣雅 3，钟丽慧 1    1.驻马店市中心医院输血科，河南 驻马店 463000；2.驻马店市中医院检验科，河南 驻马店 463000；3.驻马店市中心医院检验科，河南 驻马店 463000

      卷次： 2024年35卷10期

      【摘要】 目的 探讨血栓弹力图(TEG)与纤维蛋白原(FIB)联合预测普外科患者围术期大量输血的效能，以期为临床尽早制定合理用血方案提供参考依据。方法 回顾性选取2021年9月1日至2023年9月1日驻马店市中心医院收治的 182例普外科患者，根据围术期是否大量输血分为大量输血组(输血量≥18 U)(n=45)与非大量输血组(输血量<18 U)(n=137)。比较两组患者的临床资料、TEG参数[凝血时间指数(R)、凝固时间(K)、凝血形成速率(α角)、血栓最大幅度(MA)]和FIB水平，采用Pearson相关系数模型分析TEG参数与FIB的相关性，采用受试者工作特征曲线(ROC)及曲线下面积(AUC)评价TEG参数、FIB对普外科患者围术期大量输血的预测效能。结果 大量输血组患者的R、K [(8.57±2.31) min、(3.72±0.68) min]明显高于非大量输血组[(6.68±1.75) min、(3.15±0.50) min]，α角、MA、FIB [(44.88±4.17)°、(43.85±5.58) mm、1.(21±0.30) g/L]明显低于非大量输血组[(48.96±5.02) °、(49.76±6.41) mm、1.68±0.52 g/L)]，差异均具有统计学意义(P<0.05)；经Pearson相关性分析结果显示，R、K与FIB呈负相关(r=-0.603、-0.601 5，P<0.01)，α角、MA与FIB呈显著正相关(r=0.589、0.622，P<0.01)；R、K、α角、MA、FIB预测普外科患者围术期大量输血的AUC分别为0.755 (95%CI：0.686~0.816)、0.806 (95%CI：0.741~0.861)、0.752 (95%CI：0.683~0.813)、0.789 (95%CI：0.723~0.846)、0.807 (95%CI：0.742~0.861)，约登指数分别为 0.449、0.493、0.399、0.484、0.590，最佳截断值为 7.45 min、3.41 min、47.62°、45.86 mm、1.46 g/L，敏感度分别为 73.33%、77.78%、80.00%、66.67%、91.11%，特异度分别为 71.53%、71.53%、59.85%、81.75%、67.88%，各指标联合预测普外科患者围术期大量输血的AUC为0.924 (95%CI：0.875~0.958)，优于各指标单独预测；R、K高值的普外科患者围术期大量输血风险是低值患者的 4.201倍(95%CI：2.329~7.580)、5.108倍(95%CI：2.700~9.663)；α角、MA、FIB低值的普外科患者围术期输血风险是高值患者的 4.000倍(95%CI：2.047~7.818)、4.618倍(95%CI：2.710~7.869)、11.697倍(95%CI：4.370~31.307)。结论 TEG与 FIB联合应用可用于普外科患者围术期输血效能预测中，为临床术前预测大量输血提供参考依据，以尽早制定相应输血方案，改善预后。
      【关键词】 血栓弹力图；纤维蛋白原；围术期；输血；预测价值
      【中图分类号】 R61 【文献标识码】 A 【文章编号】 1003—6350（2024）10—1435—05

Efficacy of thromboelastography and fibrinogen in predicting perioperative massive blood transfusion in patientsundergoing general surgery.
SHAO Fang-zhen 1, YAN You-ping 1, ZHU Jun 2, CHANG Sheng-ya 3, ZHONG Li-hui 1. 1.Department of Transfusion, Zhumadian Central Hospital, Zhumadian 463000, Henan, CHINA; 2. Department of ClinicalLaboratory, Zhumadian Hospital of Traditional Chinese Medicine, Zhumadian 463000, Henan, CHINA; 3. Department ofClinical Laboratory, Zhumadian Central Hospital, Zhumadian 463000, Henan, CHINA
【Abstract】 Objective To explore the efficacy of thromboelastography (TEG) and fibrinogen (FIB) in predict-ing perioperative massive blood transfusion in patients undergoing general surgery, in order to provide a reference for theearly development of rational blood use schemes in clinic. Methods One hundred and eighty-two patients undergoinggeneral surgery admitted to Zhumadian Central Hospital from September 1, 2021 to September 1, 2023 were retrospec-tively selected and divided into the massive transfusion group (blood transfusion ≥18 U, n=45) and the non-massivetransfusion group (blood transfusion <18 U, n=137) according to whether they were heavily transfused in the periopera-tive period. The clinical data, TEG parameters [coagulation time index (R), coagulation time (K), rate of clot formation(α angle), maximum amplitude of thrombus (MA)], and FIB levels of patients in the two groups were compared. The corre-lation between TEG parameters and FIB was analyzed using the Pearson correlation coefficient model, and the receiver op-erating characteristic (ROC) curve and area under the curves (AUC) were used to evaluate the predictive efficacy of TEGparameters and FIB for perioperative massive blood transfusion in patients undergoing general surgery. Results R and Kin the massive transfusion group were (8.57±2.31) min and (3.72±0.68) min, significantly higher than (6.68±1.75) min and(3.15±0.50) min in the non-massive transfusion group; α angle, MA, FIB were (44.88±4.17)°, (43.85±5.58) mm, (1.21±0.30) g/L, significantly lower than (48.96±5.02)°, (49.76±6.41) mm, (1.68±0.52) g/L in non-massive transfusion group;the differences were statistically significant (P<0.05). Pearson correlation analysis showed that R and K were negativelycorrelated with FIB (r=-0.603, -0.601 5, P<0.01), and that α angle and MA were significantly and positively correlatedwith FIB (r=0.589, 0.622, P<0.01). The AUC of R, K, α angle, MA, and FIB for predicting perioperative massive bloodtransfusion in patients undergoing general surgery was 0.755 (95%CI: 0.686 to 0.816), 0.806 (95%CI: 0.741 to 0.861),0.752 (95%CI: 0.683 to 0.813), 0.789 (95%CI: 0.723 to 0.846), and 0.807 (95%CI: 0.742 to 0.861); the Yoden index was0.449, 0.493, 0.399, 0.484, and 0.590, respectively; the optimal cut-off value was 7.45 min, 3.41 min, 47.62°, 45.86 mm,1.46 g/L, respectively; the sensitivity was 73.33% , 77.78% , 80.00% , 66.67% , and 91.11% , and the specificity was71.53%, 71.53%, 59.85%, 81.75%, and 67.88%, respectively. The AUC of the combined detection of the indicators forpredicting perioperative massive blood transfusion in patients undergoing general surgery was 0.924 (95%CI: 0.875 to0.958), which was better than that of each index alone. The risk of perioperative massive blood transfusion in patients un-dergoing general surgery with high R and K values was 4.201 times (95%CI: 2.329 to 7.580) and 5.108 times (95%CI:2.700 to 9.663) as much as that in patients with low R and K values. The risk of perioperative blood transfusion in pa-tients undergoing general surgery with low α angle, MA, and FIB values was 4.000 times (95% CI: 2.047 to 7.818),4.618 times (95%CI: 2.710 to 7.869), and 11.697 times (95%CI: 4.370 to 31.307) as much as that in patients with high αangle, MA, and FIB values. Conclusion The combined application of TEG and FIB can provide a reference for predict-ing preoperative massive blood transfusion in patients undergoing general surgery, help doctors formulate correspondingblood transfusion schemes as early as possible, and thus improve prognosis.
      【Key words】 Thrombologram; Fibrinogen; Perioperative period; Blood transfusion; Predictive value