目的采用了能反映凝血过程全貌的血栓弹力图(TEG)作为主要方法,结合血小板计数,分析非体外循环下冠状动脉旁路移植术围术期的凝血功能。方法选取在心外科行非体外循环下冠状动脉旁路移植术的连续135例患者,无手术死亡和中转体外循环下手术。于入手术室后、入ICU时和术后24 h 3个时间点分别采全血,做TEG和血小板计数,分析比较3个点的数值的变化。结果入ICU时和术后24 h的R时间、最大幅度和血小板计数较术前减少,LY30较术前增加,差异有统计学意义(P<0.01),入ICU时和术后24 h的这4项指标差异无统计学意义。有3例患者入ICU时和术后24 h均为LY30>8%,提示存在高纤溶状态。K时间和α角度各组的差异无统计学意义。结论非体外循环下状动脉旁路移植术后部分患者处于高凝状态,少数出现高纤溶状态;术后24 h凝血功能和血小板计数较术后无明显变化。 Objective To investigate the clotting function of coronary artery bypass grafting under off-pump coronary artery bypass grafting combined with thrombocytopenia (TEG), which can reflect the whole process of coagulation, as the main method. Methods A total of 135 consecutive patients undergoing coronary artery bypass grafting under cardiopulmonary bypass were enrolled in this study. There was no operative death and no cardiopulmonary bypass. After entering the operating room, into the ICU and 24 h after surgery were taken at three time points whole blood, do TEG and platelet count, analysis and comparison of the value of the three points. Results The maximum amplitude and platelet count decreased significantly at the time of ICU and R at 24 h after operation, and LY30 increased compared with that before operation (P <0.01). At ICU and at 24 h No significant difference in the four indicators. There were 3 patients with LY30> 8% when entering the ICU and 24 h after operation, suggesting that there was a high fibrinolytic state. There was no significant difference in K time and α angle between groups. Conclusion Some of the patients after off-pump coronary artery bypass surgery were in hypercoagulable state, with a few cases of hyperfibrinolysis. The coagulation function and platelet count did not change significantly at 24 hours after operation.