血栓弹力图监测亚低温治疗对心肺复苏患者凝血功能的影响

Effect of mild hypothermia therapy on coagulation function of by monitoring thromboelastography in patients with cardiopulmonary resuscitation

目的：探讨亚低温治疗对心肺复苏（CPR）患者凝血功能的影响及血栓弹力图（thromboelastography，TEG）监测的价值。方法前瞻性选择2013-06～2015-12 ICU及EICU收治的50例心肺复苏患者，分别在体温37℃、33℃下留取静脉血，所有静脉血标本留取两份，一份送检常规凝血功能指标（PT、APTT、Fib、PLT），另外一份测定TEG，比较两种方法各指标间的相关性，分析凝血反应时间（R）、凝血形成时间（K）、凝血形成速率（Angle）、凝血最终强度（MA）和凝血综合指数（CI）等随温度变化的规律。同时根据体温37℃下CI值分为凝血功能正常和异常组，分析两组患者温度对 TEG 指标的影响和组间的差异。结果①R 与 PT、APTT 呈正相关（r＝0.435、0.461，P＜0.05），K 与 Fib、PLT 呈负相关（r＝-0.426、-0.358，P＜0.05），Angle 与 Fib、PLT 呈正相关（r＝0.396、0.374，P＜0.05），MA与Fib、PLT 呈正相关（r＝0.449、0.560，P＜0.05）。②50例CPR患者随着温度的降低，TEG的R、K值呈延长趋势，Angle、MA、CI呈降低趋势。③TEG体温从37℃降到33℃，所有指标的变化差异均有统计学意义（P＜0.05）。④体温37℃下凝血功能正常和异常两组中，R、K 值均随温度的降低而延长，而 Angle、MA、CI 值则减小，异常组的值比正常组变化更明显（P＜0.05）。结论低温对CPR患者凝血功能有较大影响，TEG测定不受温度变化的限制，能更准确地反映患者实际体温下的凝血功能，并为指导以后临床选择合适的个体化亚低温治疗温度提供一定的帮助。

Objective To investigate the effect of mild hypothermia on blood coagulation function in patients with cardiopulmonary resuscitation and the value of thromboelastography（TEG）monitoring. Methods We prospectively selected 50 cases of cardiopulmonary resuscitation in ICU and EICU from June 2013 to December 2015. Venous blood samples were collected when their temperature was 37 ℃and 33 ℃. The blood samples were used to detect coagulation function（PT, APTT and Fib, PLT）and TEG. We compared the two methods by analyzing the correlation of each index. We also analyzed the coagulation reaction time（R）, clot formation time（K）, rate of clot formation（Angle）, maximum ampli-tude（MA）and coagulation index（CI）with temperature changes. According to the temperature of 37 ℃CI, they were divided into normal and abnormal coagulation function; then we analyzed the differences of TEG index between the two groups that affected by temperature. Results ①R and PT, APTT were positively correlated（r = 0.435, 0.461, P〈0.05）; K and Fib, PLT was negatively correlated（r = -0.426, -0.358, P〈0.05）, angle and Fib; PLT were positively correlated（R, 0.374, P〈0.05）; MA and Fib, PLT were positively correlated（r = 0.449, 0.560, P〈0.05）. ②Fifity cases of cardiopulmonary re-suscitation patients with the decrease of temperature, R, K, TEG values showed a tendency to extend; An-gle, MA, CI showed a decreasing trend. ③TEG temperature from 37 ℃ to 33 ℃, all the differences be-tween the indicators were statistically significant（P〈0.05）. ④In normal blood coagulation function and abnormal groups under 37 ℃, as the temperature declined, R, K value was prolonged, and Angle, MA and CI values were decreased; but the values were more pronounced in abnormal group than those in the normal group significantly（P〈0.05）. Conclusion Low temperature has great influence on the func-tion of blood coagulation in patients with cardiopulmonary resuscitation. Determination of TEG is not re-stricted by the change of the temperature. It more accurately reflects the actual patient body temperature of coagulation function, and helps to provide guidance for clinical application of individual mild hypo-thermia treatment.