【摘要】 目的 探讨不规则抗体及血栓弹力图（TEG）在胃癌患者输血中的应用价值。方法 回顾性分析2021年5月至2022年10月在绵阳市第三人民医院行手术治疗的126例胃癌患者一般临床资料，将采用不规则抗体指导输血者纳入对照组（n=59）,将TEG检测指导输血者纳入观察组（n=67）。比较两组血常规[血红蛋白、白细胞计数（WBC）、红细胞计数（RBC）、血小板计数（PLT）]及凝血功能指标[凝血酶原时间（PT）、促凝血酶原激酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）、D-二聚体（D-D）]情况，并比较两组输血不良事件情况、肝肾功能指标。结果 不规则抗体检查发现，59例共检出10例抗筛阳性（16.95%）,主要包括Diego、MNSs、Rh、Lewis、Duffy; 67例患者经TEG检查发现凝血反应时间（R值）提示缺乏凝血因子1例，凝固时间（K值）提示纤维蛋白原高凝亢进5例，最大振幅（MA值）提示缺乏凝血因子5例，凝血综合指数（CI）提示血液低凝2例。术后，观察组WBC、PT、APTT、TT、D-D水平（11.05±1.19）×10⁹/L、（10.54±1.33） s、（28.64±2.54） s、（15.26±1.45） s、（712.36±73.69） ng/mL,均低于对照组[（15.04±1.61）×10⁹/L、（13.29±1.41） s、（34.26±3.17） s、（18.59±2.41） s、（764.21±77.41） ng/mL],血红蛋白、RBC、FIB分别为（95.41±10.33）g/L、（3.32±0.05）×10¹²/L、（5.12±0.52）g/L,均高于对照组[（73.64±8.19）g/L、（3.12±0.04）×10¹²/L、（4.29±0.43）g/L],差异均有统计学意义（P<0.05）,但两组术后PLT比较，差异无统计学意义（P>0.05）。观察组出现溶血1例，未出现血小板功能异常、血栓出血；对照组出现血小板功能异常3例，血栓出血2例，溶血2例。两组不良预后发生率比较，差异有统计学意义（1.49%vs.10.17%,P<0.05）。手术前后两组肝肾功能指标比较，差异均无统计学意义（P>0.05）。结论 不规则抗体、TEG在胃癌患者输血中均具有良好的指导意义，但后者更能降低输血不良事件发生率，推荐应用。更多还原

【Abstract】 Objective To investigate the application value of irregular antibodies and thromboelastography（TEG） in gastric cancer patients undergoing blood transfusion. Methods The general clinical data of 126 gastric cancer patients who underwent operation in Mianyang Third People’s Hospital from May 2021 to October 2022 were retrospectively analyzed. Patients who received blood transfusion guided by irregular antibodies were included in the control group（n=59）, and those who received blood transfusion guided by TEG were included in the observation group（n=67）. The blood routine[hemoglobin, white blood cell count（WBC）, red blood cell count（RBC）, platelet count（PLT）] and coagulation function indicators[prothrombin time（PT）, thromboplastin time（APTT）, thrombin time（TT）, fibrinogen（FIB）, D-dimer（D-D）] of the two groups of patients were compared. The adverse events of blood transfusion and liver and kidney function indicators were compared between the two groups.Results Irregular antibody test results showed that there were 10 antibody positive cases（16.95%）, and the irregular antibodies mainly included Rh, Lewis, MNSs, Duffy, and Diego. In the observation group, coagulation reaction time（R） of TEG indicated lack of coagulation factors in 1 patient, coagulation formation time（K） indicated fibrinogen hypercoagulable state in 5 patients, the maximum amplitude（MA） indicated lack of coagulation factors in 5 patients, and comprehensive index（CI） indicated hypocoagulable state in 2 patients. After operation, the levels of WBC, PT, APTT, TT and D-D in the observation group were（11.05±1.19）×10⁹/L,（10.54±1.33） s,（28.64±2.54） s,（15.26±1.45） s, and（712.36±73.69） ng/mL, respectively, which were lower/shorter than those in the control group[（15.04±1.61）]×10⁹/L,（13.29±1.41） s,（34.26±3.17） s,（18.59±2.41） s, and（764.21±77.41） ng/mL], and hemoglobin, RBC and FIB were（95.41±10.33） g/L and（3.32±0.05）×10¹²/L,（5.12±0.52）, g/L, respectively, which were higher than those in the control group[（73.64±8.19） g/L,（3.12±0.04）×10¹²/L,（4.29±0.43） g/L], the differences were statistically significant（P<0.05）. However, there was no statistically significant difference in postoperative PLT between the two groups（P>0.05）. There was 1 case of hemolysis in the observation group, and there was no abnormal platelet function or thrombotic bleeding; there were 3 cases of platelet dysfunction, 2 cases of thrombotic bleeding, and 2 cases of hemolysis in the control group. There was a statistically significant difference in the incidence of adverse prognosis between the two groups（1.49% vs. 10.17%, P<0.05）. There were no statistically significant differences between the two groups in liver and kidney function indicators（P>0.05）. Conclusion Both irregular antibodies and TEG can guide blood transfusion of patients with gastric cancer. However, the latter can reduce the incidence of adverse blood transfusion events.更多还原