血栓弹力图检测在70例口腔颌面部缺损游离皮瓣修复围术期中的效果评价

doi:10.19438/j.cjoms.2022.03.007

中国口腔颌面外科杂志 ›› 2022, Vol. 20 ›› Issue (3): 244-250.doi: 10.19438/j.cjoms.2022.03.007

血栓弹力图检测在70例口腔颌面部缺损游离皮瓣修复围术期中的效果评价

刘迪^1,2, 张思敏^1,2, 阿迪力江·赛买提^1,2, 祖丽胡玛·卡迪^1,2, 木合森·牙生江^1,2, 尼加提·努尔穆罕默德^1,2, 买买提吐逊·吐尔地^1,2

1.新疆医科大学第一附属医院（附属口腔医院）口腔颌面创伤正颌外科,新疆乌鲁木齐 830054;
2.新疆维吾尔自治区口腔医学研究所,新疆乌鲁木齐 830054

收稿日期:2021-11-29 修回日期:2022-01-12 出版日期:2022-05-20 发布日期:2022-05-20
通讯作者: 买买提吐逊·吐尔地,E-mail: maimaitituxun@aliyun.com
作者简介:刘迪(1995-),女,在读硕士研究生,E-mail：1528987599@qq.com

Perioperative thromboelastography evaluation in70free flap transplantations for oral, maxillofacial reconstruction

LIU Di^1,2, ZHANG Si-min^1,2, ADILIJIANG Saimaiti^1,2, ZULIHUMA Kadi^1,2, MUHESEN Yashengjiang^1,2, NIJIATI Nuermuhanmode^1,2, MAIMAITITUXUN Tuerdi^1,2

1. Department of Oral and Maxillofacial Trauma Orthognathic Surgery, The First Affiliated Hospital (Affiliated Stomatological Hospital) of Xinjiang Medical University. Urumqi 830054;
2. Stomatological Research Institute of Xinjiang Uygur Autonomous Region. Urumqi 830054, Xinjiang Uygur Autonomous Region, China

Received:2021-11-29 Revised:2022-01-12 Online:2022-05-20 Published:2022-05-20

摘要/Abstract

摘要： 目的: 探讨血栓弹力图(thromboelastography, TEG)检测在口腔颌面部缺损游离皮瓣修复围术期行抗凝治疗预防游离皮瓣吻合口血栓中的临床应用效果。方法: 回顾分析70例行口腔颌面部缺损游离皮瓣修复患者的临床资料。根据凝血检查方法及抗凝依据不同,分为对照组（常规凝血试验,根据常规凝血指标行抗凝治疗）和试验组（TEG实验和常规凝血实验,根据TEG指标行抗凝治疗）,每组35例,比较2组的凝血状态及皮瓣血栓形成、血肿等并发症。采用SPSS 24.0软件包对数据进行统计学分析。结果: 2组常规凝血试验的活化部分凝血活酶时间(APTT)、凝血酶时间（TT）水平在3个时间点依次降低,纤维蛋白原（FIB）在3个时间点水平上升,差异无统计学意义（P>0.05);国际标准化比率(INR)在3个时间点的差异无统计学意义（P>0.05）。试验组TEG中的Angle、MA、LY30%、EPL在3个时间之间的差异无统计学意义（P>0.05）,R和K值在3个时间点依次减小,差异有统计学意义（P<0.05）;术前和术后24 h,TEG实验的高凝患者阳性检出例数比常规凝血试验多,差异有统计学意义（P<0.05）。2组皮瓣并发症发生率无统计学差异（P>0.05）。结论: 血栓弹力图比常规凝血试验的高凝患者检出率高,血栓弹力图和常规凝血试验结果对抗凝药物的使用均有临床参考价值。

关键词: 口腔颌面部缺损, 游离皮瓣, 常规凝血试验, 血栓弹力图

Abstract: PURPOSE: To investigate the clinical value of thromboelastography (TEG) in prevention of thrombosis of free flap anastomosis during perioperative period of oral and maxillofacial defects reconstructed with free flap. METHODS: The clinical data of 70 patients with oral and maxillofacial defects repaired with free flap were analyzed retrospectively. According to different coagulation test methods and anticoagulation guidelines, the patients were divided into control group (routine coagulation test, anticoagulation treatment according to routine coagulation indexes) and experimental group (TEG test and routine coagulation test, anticoagulation treatment according to TEG indexes), with 35 cases in each group, their coagulation status and complications such as flap thrombosis and hematoma, etc. were compared. SPSS24.0 software package was used for statistical analysis. RESULTS: The levels of activated partial thromboplastin time(APTT) and plasma thrombin time(TT) of routine coagulation test in the two groups decreased successively at three time points, and the level of fibrinogen (FIB) increased at three time points. There was no significant difference between the two groups (P>0.05); the difference of international normalized ratio (INR) at three time points was not statistically significant (P>0.05). There was no significant difference in Angle, MA, LY30% and EPL at three time points in TEG of the experimental group (P>0.05). The values of R and K decreased successively at three time points, and the difference was statistically significant (P<0.05); before operation and 24h after operation, the number of positive cases of hypercoagulable patients in TEG test was greater than that in routine coagulation test, and the difference was statistically significant(P<0.05). There was no significant difference in flap complications between the two groups (P>0.05). CONCLUSIONS: The detection rate of TEG in hypercoagulable patients was higher than that in routine coagulation test; the results of TEG and routine coagulation test have clinical reference value for the use of anticoagulants.

Key words: Oral and maxillofacial defect, Free flap, Routine coagulation test, Thromboelastogram

中图分类号:

R782.05

刘迪, 张思敏, 阿迪力江·赛买提, 祖丽胡玛·卡迪, 木合森·牙生江, 尼加提·努尔穆罕默德, 买买提吐逊·吐尔地. 血栓弹力图检测在70例口腔颌面部缺损游离皮瓣修复围术期中的效果评价[J]. 中国口腔颌面外科杂志, 2022, 20(3): 244-250.

LIU Di, ZHANG Si-min, ADILIJIANG Saimaiti, ZULIHUMA Kadi, MUHESEN Yashengjiang, NIJIATI Nuermuhanmode, MAIMAITITUXUN Tuerdi. Perioperative thromboelastography evaluation in70free flap transplantations for oral, maxillofacial reconstruction[J]. China J Oral Maxillofac Surg, 2022, 20(3): 244-250.

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血栓弹力图检测在70例口腔颌面部缺损游离皮瓣修复围术期中的效果评价

Perioperative thromboelastography evaluation in70free flap transplantations for oral, maxillofacial reconstruction

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