血栓弹力图在判断脓毒症患者早期凝血功能异常中的价值

The value of thrombelastography in the early recognition of sepsis patients with coagulant function abnormality

目的 探讨血栓弹力图（TEG）在早期识别脓毒症患者凝血功能异常中的价值.方法 选择30例脓毒症患者,入院72 h内同步进行TEG和常规凝血检查,同期记录患者的弥散性血管内凝血（DIC）评分,分析脓毒症患者的凝血特点,比较TEG、常规凝血试验、DIC评分的相关性.结果 脓毒症患者常规凝血中纤维蛋白原（Fg）、纤维蛋白降解产物（FDP）、D-二聚体（D-D）明显升高,TEG的α角、MA值和CI综合指数明显增大,差异有统计学意义（P ＜0.05）;TEG检测的多项参数与常规凝血试验指标存在相关性,R值与国际标准化率（INR）正相关;K值与部分凝血活酶时间（APTT）、凝血酶原时间（PT）、INR、凝血酶时间（TT）正相关,与Fg负相关;α角和CI与APTT负相关;MA值与TT负相关,与Fg正相关;DIC评分与APTT、PT、INR、TT、D-D多项常规凝血检验结果中度正相关,与Fg高度正相关;DIC评分与TEG中的R值和K值正相关,与α角、MA值、CI值无明显的相关性.结论 脓毒症患者早期多数存在血液高凝状态,TEG较常规凝血试验能够更早地提示凝血功能异常,在脓毒症患者凝血功能异常中的早期诊断价值更大.

Objective To explore the value of thrombelastography in the early recognition of sepsis patients with coagulant function abnormality.Methods 30 patients with sepsis were included.Thrombelastography and conventional coagulation test were detected within 72 hours after admission,meanwhile DIC score was evaluated.Blood coagulation characteristics of patients with sepsis were analyzed.The correlation of conventional coagulation experiment,thrombelastography and DIC score were compared.Results Fibrinogen （Fg）,fibrinogen degradation products （FDP）,D-dimer （D-D）,α angle,maximal amplitude （MA） and comprehensive index （CI） were significantly higher in patients with sepsis.There were correlations between the TEG and conventional coagulation tests.Reaction time （R） was positively correlated with international normalized ratio （INR） ; Prothrombin formation time （K） was positively correlated with the activated partial thromboplastin time （APTT）,prothrombin time （PT）,thrombin time （TT） and was negatively correlated with Fg; α angle and CI were negatively correlated with APTT; MA was negatively correlated with TT and was positively correlated with Fg.DIC score was moderately positively related with APTT,PT,INR,TT and D-D and highly positively correlated with Fg; DIC score was moderately positively correlated with the R value and K value; There was no obvious correlation with DIC score,α angle and MA value.Conclusion Blood hypercoagulable state exists in most of patients with sepsis.Compared with conventional coagulation experiments,thrombelastography can earlier prompt coagulant function abnormality and predict the early coagulation abnormality of sepsis patients.