血栓弹力图血块形成时间和最大振幅预测乙型肝炎肝硬化中心静脉置管术后出血的有效性

肝脏 ›› 2024, Vol. 29 ›› Issue (10): 1239-1242.

血栓弹力图血块形成时间和最大振幅预测乙型肝炎肝硬化中心静脉置管术后出血的有效性

张莉, 王梦杰, 孙梦秋

221000 江苏徐州市中心医院输血科(张莉,孙梦秋);222000 连云港市第一人民医院/徐州医科大学附属连云港医院输血科(王梦杰)

收稿日期:2023-09-26 出版日期:2024-10-31 发布日期:2024-12-02
通讯作者: 孙梦秋,Email:18168779345@163.com
基金资助:
徐州市科技计划项目(KC22174);江苏省基础研究计划(青年基金)项目(BK20210081)

Effectiveness of thromboelastogram clot formation time (K value) and maximum amplitude in predicting bleeding after central vein catheterization in patients with hepatitis B cirrhosis

ZHANG Li, WANG Meng-jie, SUN Meng-qiu

1. Department of Blood transfusion, Xuzhou Central Hospital, Jiangsu 221000, China;
2. Department of Blood Transfusion,Lianyungang First People's Hospital/Xuzhou Medical University Affiliated Lianyungang Hospital, Jiangsu 222000, China

Received:2023-09-26 Online:2024-10-31 Published:2024-12-02
Contact: SUN Meng-qiu,Email:18168779345@163.com

摘要/Abstract

摘要： 目的探讨血栓弹力图血块形成时间(K值)、最大振幅预测乙型肝炎肝硬化中心静脉置管术后出血的有效性。方法回顾性分析2021年5月—2022年5月徐州市中心医院收治的行中心静脉置管术的166例乙型肝炎肝硬化患者的临床资料,根据术后是否出血分为出血组(n=45)与未出血组(n=121)。所有患者予血栓弹力图(TEG)检测,对各项指标进行单因素分析,并将其中差异有统计学意义的变量纳入多因素logistic回归分析,从而筛选出预测乙型肝炎肝硬化中心静脉置管术后出血的危险因素,采用受试者工作特征曲线(ROC)分析各项危险因素预测乙型肝炎肝硬化中心静脉置管术后出血的价值。结果单因素分析结果显示,两组患者凝固时间(K)、国际标准化比值(INR)、最大振幅(MA)比较差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,K时间≥3.05 min、INR≥2.6是乙型肝炎肝硬化中心静脉置管术后出血的危险因素(OR=5.613、5.703,P<0.05),MA≥48.8 mm是乙型肝炎肝硬化中心静脉置管术后出血的保护因素(OR=0.874,P<0.05)。ROC曲线分析结果显示,K、MA、INR预测乙型肝炎肝硬化中心静脉置管术后出血的曲线下面积为0.878、0.858、0.854,预测效能较好。结论血栓弹力图血块形成时间(K值)、最大振幅预测乙型肝炎肝硬化中心静脉置管术后出血价值较高,K时间≥3.05 min、INR≥2.6是乙型肝炎肝硬化中心静脉置管术后出血的危险因素,MA≥48.8 mm是乙型肝炎肝硬化中心静脉置管术后出血的保护因素。

关键词: 肝硬化, 血栓弹力图, 中心静脉置管, 出血

Abstract: Objective To explore the effectiveness of predicting bleeding events after central venous catheterization in patients with hepatitis B cirrhosis by using thromboelastogram (TEG) clot formation time (K value) and maximum amplitude (MA). Methods The clinical data of 166 patients with hepatitis B cirrhosis who underwent central venous catheterization between May 2021 and May 2022 at Xuzhou Central Hospital were retrospectively analyzed. They were divided into bleeding group (n=45) and non-bleeding group (n=121) according to whether there was bleeding after surgery. All patients were tested by TEG, and univariate analysis was conducted for each index. The statistically significant variables in the univariate analysis were included in the multiple logistic regression analysis, so as to screen out the risk factors predicting the bleeding after central vein catheterization for hepatitis B cirrhosis. The value of each risk factor to predict the bleeding after central vein catheterization for patients with hepatitis B cirrhosis was analyzed using the receiver operating characteristic curve (ROC). Results The results of univariate analysis showed that there were statistically significant differences in coagulation time (K), international normalized ratio (INR) and MA between the two groups (P<0.05). Multivariate Logistic regression analysis showed that K time ≥3.05 min and INR≥2.6 were the risk factors for bleeding after central venous catheterization in patients with hepatitis B cirrhosis (OR=5.613 and 5.703, P<0.05), and MA≥48.8 mm was the protective factor for bleeding after central venous catheterization in patients with hepatitis B cirrhosis (OR=0.874, P<0.05). ROC curve analysis showed that the area under the curve of K, MA, INR to predict the bleeding after central vein catheterization is 0.878, 0.858, 0.854 respectively, with a good prediction efficiency. Conclusion TEG blood clot formation time (K value) and MA have a high value in predicting the bleeding after central vein catheterization in patoents with hepatitis B cirrhosis. K time ≥ 3.05 min and INR ≥ 2.6 are risk factors, and MA ≥48.8 mm was the protective factor for bleeding after central vein catheterization in hepatitis B cirrhosis patients.

Key words: Cirrhosis, Thromboelastogram, Central venous catheterization, Bleeding event

张莉, 王梦杰, 孙梦秋. 血栓弹力图血块形成时间和最大振幅预测乙型肝炎肝硬化中心静脉置管术后出血的有效性[J]. 肝脏, 2024, 29(10): 1239-1242.

ZHANG Li, WANG Meng-jie, SUN Meng-qiu. Effectiveness of thromboelastogram clot formation time (K value) and maximum amplitude in predicting bleeding after central vein catheterization in patients with hepatitis B cirrhosis[J]. Chinese Hepatolgy, 2024, 29(10): 1239-1242.

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