常规凝血指标和血小板计数与血栓弹力图判断危重型蝮蛇咬伤患者严重程度的临床价值

Clinical Value of Common Coagulation Indicators, Blood Platelet Count and Thrombelastogram in Determining the Condition Severity of Critical Patients With Agkistrodon Halys Bite

目的探讨危重型蝮蛇咬伤患者常规凝血指标、血小板计数(PLT)和血栓弹力图(TEG)对病情严重程度的评估价值。方法选取2010年1月—2014年1月中国人民解放军总医院第一附属医院急救部治疗的危重型蝮蛇咬伤患者68例为研究对象。按局部伤口、神经毒症状、血循毒症状的第2高分,将患者依次分为非危重组(20例)、危重组(27例)和极危重组(21例)。检测常规凝血功能指标〔活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(DD)〕和PLT,描绘TEG,记录血凝时间(R)、血块成型时间(K)、α角和血块强度(MA)。结果 3组APTT、TT比较,差异无统计学意义(P>0.05)。3组PT、FIB、DD和PLT比较,差异有统计学意义(P<0.05);其中,极危重组PT、DD高于非危重组和危重组,极危重组FIB、PLT低于非危重组和危重组,差异有统计学意义(P<0.05)。3组R、K、α角和MA比较,差异均有统计学意义(P<0.05);其中,极危重组R、K较非危重组和危重组延长,极危重组α角、MA小于非危重组和危重组,差异有统计学意义(P<0.05)。APTT、TT、PT和PLT与R呈正相关(r=0.379、0.571、0.061、0.645,P<0.05);TT、PT、DD与K呈正相关(r=0.637、0.611、0.521,P<0.05),FIB、PLT与K呈负相关(r=-0.371、-0.723,P<0.05);TT、PT与α角呈负相关(r=-0.687、-0.702,P<0.05),FIB、PLT与α角呈正相关(r=0.335、0.728,P<0.05);APTT、TT、PT与MA呈负相关(r=-0.567、-0.787、-0.679,P<0.05),FIB、PLT与MA呈正相关(r=0.329、0.639,P<0.05)。结论常规凝血功能指标、PLT及TEG对判断危重型蝮蛇咬伤患者病情严重程度有重要参考价值,其可以较好地评估患者凝血功能状态,有助于提供精确治疗。

Objective To investigate the evaluation value of common coagulation indicators, blood platelet count （PLT）and thrombelastogram（TEG）on the condition severity of critical patients with agkistrodon halys bite. Methods We enrolled 68 critical patients with agkistrodon halys bite who received treatment in the Department of Emergency, the First Affiliated Hospital of Chinese PLA General Hospital from January 2010 to January 2014. According to the second highest score among the scores of partial wound,neurotoxicant symptom and blood cycle poison,the subjects were divided into non severe group（n=20）,severe group（n =27）and critical group（n =21）. The common coagulation indicators were examined, including activated partial thomboplastin time（ APTT）,thrombin time（ TT）,prothrombin time（ PT）,fibrinogen（ FIB）,D-dimer（ DD）. The PLT was also examined. TEG was made to monitor reaction time（ R）,kinetics of clot development（ K）,αangle and maximum amplitude（MA）. Results The three groups were not significantly different（P〉0. 05）in APTT and TT and were significantly different（P〈0. 05） in PT,FIB,DD and PLT;compared with the non severe group and the severe group,the critical group was higher（P〈0. 05）in PT and DD,and lower（P〈0. 05）in FIB and PLT. The three groups were significantly different（P〈0. 05）in R,K,α angle and MA;compared with the non severe group and the severe group,the critical group was longer（P〈0. 05）in R and K and was lower（P〈0. 05）inαangle and MA. APTT,TT,PT and PLT were positively correlated（r=0. 379,0. 571,0. 061,0. 645;P〈0. 05）with R;TT,PT and DD were positively correlated（r=0. 637,0. 611,0. 521;P〈0. 05）with K;FIB and PLT were negatively correlated（r= -0. 371,-0. 723;P〈0. 05）with K;TT and PT were negatively correlated（r = -0. 687,-0. 702;P 〈0. 05）with α angle;FIB and PLT were positively correlated（ r = 0. 335,0. 728;P 〈 0. 05 ） with α angle;APTT, TT and PT were negatively correlated （ r = - 0. 567,-0. 787,-0. 679;P〈0. 05）with MA;FIB,PLT were positively correlated（r =0. 329,0. 639;P 〈0. 05）with MA. Conclusion Common coagulation indicators,PLT and TEG are of important reference value in determining the condition severity of critical patients with agkistrodon halys bite. They can better evaluate patients blood coagulation function state,provide more accurate treatment.