Khảo sát tình trạng đông máu trên bệnh nhân phẫu thuật tim có sử dụng tuần hoàn ngoài cơ thể bằng xét nghiệm ROTEM=Evaluate coagulation status in on-pump cardiac surgery patients with ROTEM test

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Tác giả: Tất Cường Lê, Trung Thành Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Y học cộng đồng, 2023

Mô tả vật lý: tr.159-168

Bộ sưu tập: Metadata

ID: 477574

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To evaluate coagulopathy and its associated factors among patients who underwent on-pump cardiac surgery in Cho Ray hospital using ROTEM test in the post-weaning cardiopulmonary bypass period. Methods: A cross-sectional study was conducted in patients who underwent on-pump cardiac surgery in Cho Ray hospital. ROTEM tests were performed after weaning cardiopulmonary bypass. Results: Coagulopathy in the cardiopulmonary bypass phase accounted for 84.2%, of which 71.9% of patients had fibrinogen deficiency, 43.9% of patients lacked coagulation factors, and 15.8% of patients had platelet dysfunction. Coagulation disorder post-cardiopulmonary bypass weaning accounted for 62.4%, with 20% of patients having thrombocytopenia, 17.6% of patients having platelet disorder, 54.1% of patients lacking coagulation factors, 8.2% of patients having heparin residue, and 12.9% of patients having increased fibrinolysis status. Conclusions: Coagulopathy is common in on-pump cardiac surgery patients during and post-cardiopulmonary bypass. Certain coagulopathies are related to the time of cardiopulmonary bypass and the level of hypothermia. Therefore, ROTEM tests should be performed soon in on-pump cardiac surgery patients, especially in complex surgeries where prolonged bypass time and deep hypothermia are required.Xác định tỷ lệ các rối loạn đông máu trên bệnh nhân phẫu thuật tim sử dụng tuần hoàn ngoài cơ thể (THNCT) bằng xét nghiệm đo đàn hồi cục máu đồ (ROTEM) và khảo sát các yếu tố liên quan đến các rối loạn đông máu sau THNCT. Đối tượng và phương pháp: Nghiên cứu mô tả cắt ngang có phân tích trên bệnh nhân phẫu thuật tim có sử dụng THNCT tại Bệnh viện Chợ Rẫy bằng xét nghiệm ROTEM. Kết quả: Rối loạn đông máu trong khi THNCT chiếm 84,2%. Trong đó, 71.9% có giảm fibrinogen, 43.9% có thiếu yếu tố đông máu và 15.8% có rối loạn tiểu cầu. Các rối loạn đông máu sau khi THNCT chiếm 62,4%. Trong đó, 20.0% có rối loạn giảm fibrinogen, 17.6% có rối loạn tiểu cầu, 54.1% có thiếu các yếu tố đông máu, 8.2% có tồn dư heparin và 12.9% có tăng tiêu sợi huyết. Giảm fibrinogen và rối loạn tiểu cầu có liên quan với thời gian THNCT (p<
0,001 và p=0,003) và mức độ hạ thân nhiệt (p=0,002 và p=0,006). Tăng tiêu sợi huyết có liên quan với mức độ hạ thân nhiệt (p=0,045). Kết luận: Rối loạn đông máu ở bệnh nhân phẫu thuật tim trong và sau THNCT rất phổ biến. Một số rối loạn đông máu có liên quan với thời gian THNCT và mức độ hạ thân nhiệt. Xét nghiệm ROTEM nên được sử dụng trên bệnh nhân phẫu thuật tim có sử dụng THNCT
các phẫu thuật phức tạp, có thời gian THNCT kéo dài và cần hạ thân nhiệt sâu.

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