旋转血栓形成仪 (ROTEM) 与肝硬化中的常规凝血测试:我们可以在没有ROTEM的情况下减少血输血吗?
Nuanrat Cheerasiri1, Ratchaneekorn Jantasing1, Rapat Pittayanon2,3
1Center of Excellence in Translational Hematology, Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Journal of clinical laboratory analysis
|November 25, 2025
概括
旋转血栓形成显微镜 (ROTEM) 与肝硬化患者的常规凝血试验 (CCT) 有很强的相关性,但不能改善再平衡血静的检测. 调整PT-R和血小板计数的输血值可能会减少不必要的输血.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 凝血科学 凝血科学
- 输血医学 输血医学
背景情况:
- 围绕手术的旋转血小板造影仪 (ROTEM) 正在探索如何减少肝硬化患者的输血.
- 不确定性存在于ROTEM的好处是否源于更高的输血门或检测重新平衡的血液静止.
研究的目的:
- 评估常规凝血试验 (CCT) 与肝硬化患者ROTEM之间的相关性.
- 确定ROTEM是否与CCT有相同的限制,特别是关于抗凝蛋白水平.
主要方法:
- 一项队列研究分析了接受选择性内镜检查的肝硬化患者的血液样本.
- 评估了CCT参数 (PT-R) 和ROTEM变量 (EXTEM-CT,EXTEM-MCF) 之间的相关性.
- 测量了抗凝蛋白水平,以评估ROTEM的限制.
主要成果:
- 在PT-R和EXTEM-CT,血小板数和EXTEM-MCF,纤维素和FIBTEM/EXTEM-MCF之间发现了很高的相关性.
- 只有41.7%的PT-R>1.5的患者超过了ROTEM输血值.
- 低血小板计数与EXTEM-MCF受损相关;长时间的EXTEM-CT与较低的蛋白C和抗血水平有关.
结论:
- ROTEM与CCT有很强的相关性,但无法克服它们在检测再平衡血液静止方面的局限性.
- 应避免仅基于异常ROTEM或CCT的预防性输血.
- 在活跃出血期间增加PT-R (>1.8) 和血小板计数 (<40 × 10 ^ 9 / L) 的输血门可能会减少不必要的输血.
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