激活凝血时间用于严重创伤病人术中检测的可行性研究

Feasibility of intraoperative detection of severe trauma patients using the activated coagulation time

目的探讨激活凝血时间(ACT)用于严重创伤病人术中凝血功能监测的可行性。方法对实施急诊手术的严重创伤病人(ISS>16分)38例进行前瞻性研究。于麻醉后手术前、手术开始后30min和手术结束时分别测定(ACT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)并测定病人手术前体温和动脉血pH值。结果严重创伤病人术前ACT值低于正常,但差异无统计学意义(P>0.05),手术中和手术结束时的ACT值则明显高于正常(P<0.05),并且与PT、APTT及TT均显著正相关。凝血病创伤病人的ACT值高于非凝血病创伤病人,差异有统计学意义(P<0.001),单次ACT升高达160s以上时,发生凝血病的敏感性为87%,特异性为93%。结论ACT是总体凝血状况的敏感、快速和经济的检测指标,能为严重创伤手术病人凝血功能紊乱提供可靠诊断依据。

Objective To study the feasibility of intraoperative detection of severe trauma patients using activated coagulation time(ACT). Methods A prospective protocol was used to study 38 victims of severe trauma who underwent immediate intervention (ISS>16). ACT, prothrombin time(PT), activated partial thromboplastin time (APTT),and thrombin time(TT) were detected after induction of anesthesia, 30 min after the start of operation and by the end of operation,and pH and temperature were determined at the beginning of surgery. Results The ACT value of the severe trauma patients was lower than normal, whereas the ACT values were significantly elevated intraoperatively and at the end of surgery. The ACT value of was coagulopathic trauma patients was significantly elevated compared with other trauma patients (P<0.001).ACT had positive correlation with PT, APTT, and TT. Using clinical coagulopathy as the standard, a single elevated ACT above 160s carriesd a sensitivity of 87% and a specificity as of 93%. Conclusion ACT is a sensitive, rapid, and inexpensive indicator of the global coagulation status and may be viewed as a new way to detect global coagulation derangements in operative trauma victims.