Temperature effect on coagulation function in mild hypothermic patients undergoing thoracic surgeries: thromboelastography (TEG) versus standard tests.

IF 2 3区 医学 Q2 ANESTHESIOLOGY Perioperative Medicine Pub Date : 2024-06-12 DOI:10.1186/s13741-024-00405-8
Shangyi Hui, Qian Zhang, Jiaxin Lang, Jie Yi
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Abstract

Purpose: Our previous research has revealed that mild hypothermia leads to excessive bleeding in thoracic surgeries, while the underlying mechanism stayed unrevealed by the standard coagulation tests. The research question in this study was as follows: "How does mild hypothermia impair the hemostatic function in patients receiving thoracic surgeries?". The purpose was to detect the disturbed coagulation processes by comparing the TEG parameters in patients receiving active vs. passive warming during thoracic surgeries.

Methods: Standard coagulation tests and thromboelastography (TEG) were adopted to compare the hemostatic functions in patients receiving active vs. passive warming during thoracic surgeries. Furthermore, blood samples from passive warming group were retested for TEG at actual core body temperatures.

Results: Sixty-four eligible patients were included in this study. TEG revealed that mild hypothermia significantly disturbed coagulation by decreasing MA (59.4 ± 4.5 mm vs. 64.2 ± 5.7 mm, p = 0.04) and α angle (70.4 ± 5.2° vs. 74.9 ± 4.4°, p = 0.05) and prolonging ACT (122.2 ± 19.3 s vs. 117.3 ± 15.2 s, p = 0.01) and K time (1.9 ± 1.0 s vs. 1.3 ± 0.4 min, p = 0.02). TEGs conducted under core body temperatures revealed more impaired coagulation than those incubated at 37 °C. Furthermore, postoperative shivering and waking time were significantly increased in mild hypothermic patients.

Conclusion: Mild hypothermia significantly impaired coagulation function in patients receiving thoracic surgeries, which could be detected by TEGs other than the standard coagulation tests. Temperature-adjusted TEGs may provide a preferable method of hemostatic monitoring and transfusion guidance in thoracic surgeries, which warrants further clinical investigations.

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胸外科手术中轻度低体温患者的温度对凝血功能的影响:血栓弹性成像(TEG)与标准测试对比。
目的:我们之前的研究发现,轻度低体温会导致胸腔手术出血过多,而标准的凝血测试却无法揭示其根本机制。本研究的问题如下:"轻度低体温如何损害胸外科手术患者的止血功能?目的是通过比较胸外科手术期间接受主动加温和被动加温的患者的 TEG 参数,检测凝血过程是否受到干扰:方法:采用标准凝血测试和血栓弹力图(TEG)来比较胸外科手术中主动与被动保暖患者的止血功能。此外,被动保暖组的血液样本在实际核心体温下重新进行了 TEG 检测:本研究共纳入 64 名符合条件的患者。TEG显示,轻度低体温会显著干扰凝血功能,降低MA(59.4 ± 4.5 mm vs. 64.2 ± 5.7 mm,p = 0.04)和α角(70.4 ± 5.2° vs. 74.9 ± 4.4°,p = 0.04)。74.9 ± 4.4°,p = 0.05)和延长 ACT(122.2 ± 19.3 秒 vs. 117.3 ± 15.2 秒,p = 0.01)和 K 时间(1.9 ± 1.0 秒 vs. 1.3 ± 0.4 分钟,p = 0.02)。在核心体温下进行的 TEG 比在 37 °C 下培养的 TEG 显示出更严重的凝血功能受损。此外,轻度低体温患者术后哆嗦和苏醒时间明显增加:结论:轻度低体温会明显损害胸外科手术患者的凝血功能,这可以通过标准凝血测试以外的 TEG 检测出来。温度调整型 TEG 可为胸外科手术中的止血监测和输血指导提供一种更好的方法,值得临床进一步研究。
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3.80%
发文量
55
审稿时长
10 weeks
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