血栓弹力图对脓毒血症病程鉴别价值研究

Investigation of the Value of Differential Diagnosis of Sepsis Duration by Thrombelastograph

目的观察脓毒血症病程中血栓弹力图(Thrombelastograph,TEG)参数的差异,探讨血栓弹力图对脓毒血症病程严重程度的鉴别价值。方法回顾性分析脓毒血症致死的患者病程变化,以临床诊断和APACHEII系统为分组依据,检测28例脓毒血症患者在脓毒血症各个典型病期的TEG的变化,统计脓毒血症早期(a组)、严重脓毒血症(b组)、脓毒血症休克(c组)、多器官功能衰竭(d组)中R(reaction time)、K(coagulation time)、α(alpha angle)、MA(maximum amplitude)的差异,量化分析TEG与APACHEII评分的关系,评价TEG参数对脓毒血症病程的鉴别价值。结果脓毒血症病程发展不同时期的APACHEII评分差异明显,脓毒血症严重程度与APACHEII评分呈正相关(r=0.662,P<0.01);不同病情程度的脓毒血症,TEG参数R、K、α、MA有明显区别。根据病程与TEG参数的相关性分析发现,R和MA与脓毒学症的病程存在相关性,而K和α仅在多器官功能衰竭出现前存在差异。结论 TEG参数在脓毒血症病程发展中所表现出的差异性和病程相关性,预示了TEG对脓毒血症严重程度具有鉴别能力,同时提示脓毒血症发展与凝血功能的紊乱密切相关。

Objective To observe the difference about hrombelastography（ Thrombelastograph,TEG） parameters in the course of sepsis,and investigate the value to diagnose the severity of sepsis by thrombelastography. Methods According to clinical diagnostics and APACHEII system,28 cases of sepsis patients were divided into Noxious Early disease（ a group）,severe sepsis（ b group）,septic shock（ c group）,multiple organ failure（ d group）,retrospectively analyzed and detected changes in TEG in all course statistical and the changes of R（ reaction time）,K（ coagulation time）,α（ alpha angle）,the difference MA（ maximum amplitude） 。the quantitative analysis of the relationship between TEG and APACHEII score,the dignositic value of TEG parameters were evaluated on the course of the of sepsis. Results APACHEII score was significantly different at sepsis progression,severity of score with sepsis was positively correlated with APACHEII（ r = 0. 662,P〈0. 01）. Different severity of sepsis,TEG parameters R,K,α,MA were apparently different. According to correlation analysis of the course and TEG parameters,R and MA had a correlation with course of sepsis disease,but there were obvious differences between K and α just before the emergence of multiple organ failure. Conclusion The relevance and differences of TEG parameters in the progression of sepsis,indicate the ability to identify of sepsis TEG,at the same time prompted the development of sepsis and coagulation disorders.