血栓弹力图检测与常规凝血试验指导重症感染患者血浆输注的疗效对比分析

Comparative analysis on the curative effect of the plasma transfusion in patients with severe infection by thromboelastography or routine coagulation tests

目的对比分析采用血栓弹力图(TEG)检测和常规凝血试验指导临床血浆输注的重症感染患者的预后及生存期的差异。方法在重症感染患者中选择血栓弹力图检测结果与常规凝血试验检测结果不一致的患者50例,分为2组:常规组,常规凝血试验结果指导血浆输注;TEG组,TEG检测结果指导血浆输注,追踪2组患者的临床预后及生存期的差异。结果重症感染患者均表现为APTT、PT、FDP、D-二聚体均明显升高,R时间正常或缩短,MA值明显增大(均为与正常参考值上限相比);TEG组生存期明显长于常规组(χ2=14.713,P<0.05)。结论重症感染患者的凝血试验结果与TEG检测结果不一致时,用TEG检测指导临床血浆输注,患者将获得更长的生存期,相关机制有待进一步探索。

Objective To analyze the differences in prognosis and survival by the use of thromboelastography（ TEG） or routine coagulation test to guide clinical plasma infusion in patients with severe infection. Methods Fifty cases of severe infection patients,whose TEG test results were not consistent with the result of routine coagulation test,were chosen and divided into two groups. A control group was established according to the routine coagulation test results to guide the plasma infusion. A TEG group was established according to the testing results of TEG guidance plasma infusion. The clinical prognosis and survival differences of the two groups were analyzed. Results The APTT,PT,FDP and D-dimer were significantly higher than normal value,R-time was normal or shortened,and MA value increased notably（ compared with the upper limit of normal reference value） in all selected patients with severe infection. The prognosis was significantly longer in TEG group than the control group（ χ^2= 14. 713,P 〈0. 01）. Conclusion Clinical plasma infusion should use TEG when coagulation test results are not consistent with TEG test results. Patients with severe infections will have longer prognoses. However,related mechanism needs further exploration.