快速血栓弹性描记图在创伤性凝血病诊治中的研究进展

Progress of rapid thrombelastography in acute traumatic coagulopathy

背景 严重创伤所致的凝血功能紊乱可使出血难以控制，是创伤早期死亡的主要原因；即或一些患者已接受了外科止血，仍可能死于难治性凝血功能障碍。目前创伤引起的凝血功能障碍仍是改善严重创伤患者预后的难题之一。 目的 评估血栓弹性描记图（thromb-elastography， TEG）尤其是快速TEG（rapid thromb-elastography， r-TEG）在创伤医学中应用的优势。 内容 传统的凝血试验不能全面和快速地评估机体凝血纤溶过程及血小板功能，而黏弹性止血试验技术弥补了此不足。通过在创伤动物模型和创伤患者中应用r-TEG，证实其能在较短时间内评价患者的凝血、纤溶及血小板功能状况，预测患者的输血需求。 趋势 TEG引入创伤医学通过r？蛳TEG测定已得到了发展，其参数能尽早判断创伤性凝血病的存在以进行早期目标导向凝血治疗。

Background It is difficult to control bleeding of coagulopathy induced by severe trauma. Coagulopathy is the main cause of death in the early phase of trauma. Some patients may died of refractory coagulopathy, even if they had received surgery to control bleeding. Trauma-induced coagulopathy is still one of the problems to improve the prognosis of patients with severe trauma. Objective The advantage of application of thromb-elastography（TEG） especially rapid thromb-elastography（r-TEG） test for trauma was evaluated. Content Traditional coagulation tests can not evaluate status of coagulation, fibrinolysis and platelet comprehensively and quickly during trauma, but viscoelastic haemostasis assays make up for this deficiency. Application of r-TEG in traumatic animal models and traumatic patients was confirmed which can evaluate the status of coagulation, fibrinolysis and platelet rapidly, predict transfusion needs of patients. Trend TEG has been developed by rapid TEG in traumatic medicine. The parameters can identify the acute traumatic coagulopathy as soon as possible, guide the early goal-directed coagulation therapy.