关键词: TEG/ROTEM, 肝硬化静脉曲张出血, 出血量预测

Abstract: Objective To explore the value of thromboelastogram (TEG)/rotational thromboelastometry (ROTEM) in predicting the bleeding amount of cirrhotic patients with esophageal variceal bleeding (EVB) and for guiding the study of blood preparation.Methods One hundred patients with EVB who were diagnosed and treated in our hospital from July 2021 to October 2022 were randomly divided into an experimental group and a conventional group according to the random grouping software, with 50 patients in each group. The conventional group and the experimental group were given traditional common caugulation tests (CCTs) guidance and TEG guidance respectively. The difference of coagulation index, blood product dosage and prognosis before and after transfusion were observed.Results There was little difference in the amount of concentrated red blood cells (CRC) between the two groups (t=3.244, P>0.05); The input of fresh frozen plasma (FFP), Platelet concentrates (PC) and cryoprecitation (CRYO) in the experimental group were significantly lower than those in the conventional group (t=6.866, 8.335, 10.256, P<0.05); The number of patients in the routine group who need to inject two kinds of blood products during treatment was significantly more than that in the experimental group (χ²=12.245, P<0.05), and the number of patients in the routine group who do not need to inject related blood products during treatment was significantly less than that in the experimental group (χ²=8.051, P<0.05). In addition, the number of patients with blood transfusion reaction in the conventional group was significantly more than that in the experimental group (χ²=9.256, P<0.05). The blood transfusion reaction of all patients was slight, and no severe blood transfusion reaction such as heart failure, hemolysis, shock occurred. Before treatment, the levels of coagulation related indicators of patients in the two groups were similar, without statistical difference (P>0.05). After treatment, the coagulation related indicators of patients were significantly improved,(P<0.05). The related values of coagulation related indicators in the conventional group were lower than those in the experimental group, indicating that the improvement in the experimental group was significantly better (P<0.05). There was no significant difference in the success rate of hemostasis, rebleeding rate, mortality, hepatic encephalopathy and ascites incidence, between the two groups (χ²= 0.762, 0.271, 1.010, 0.211, 0.298, P<0.05).Conclusion Compared with blood transfusion guided by routine coagulation, the TEG/ROTEM guided blood transfusion scheme can significantly reduce the amount of blood products, without reducing the success rate of hemostasis and increasing the rate of rebleeding, mortality, and the incidence of hepatic encephalopathy and ascites, thus is worth of clinical promotion.

Key words: TEG/ROTEM, Liver cirrhosis variceal bleeding, Hemorrhage prediction