血栓弹力图评价多发伤患者凝血功能障碍

Evaluation of Coagulation Disorders with Thrombelastography in Patients with Multiple Trauma

目的比较血栓弹力图(TEG)与常规凝血试验在多发伤患者中的检测结果,探讨TEG对监测多发伤患者凝血功能障碍的作用。方法以60例多发伤患者为研究对象,根据创伤严重程度评分(ISS评分)不同分为2组(ISS<16分组及ISS≥16分组),另选30例同期住院的非多发伤且凝血功能正常者作为对照组。对比分析3组间常规凝血指标、血常规、D-二聚体及TEG检测的变化。结果在常规凝血试验指标中,ISS评分<16分组与对照组比较,凝血酶原时间(PT)及国际标准化比值(INR)的升高差异无统计学意义(P>0.05);D二聚体呈逐渐升高趋势,血小板呈逐渐下降趋势(P<0.05)。TEG参数中,凝血反应时间(R时间)和血块生成时间(K时间)在ISS评分<16分组低于对照组[R时间(min):4.33±0.51 vs 7.56±1.52,K时间(min):1.08±0.21 vs 2.08±0.51,P<0.01],在ISS≥16分组则高于对照组[R时间(min):13.33±1.89 vs 7.56±1.52,K时间(min):3.57±0.67 vs 2.08±0.51,P<0.01];血块生成率(α角)及凝血综合指数(CI值)在ISS<16分组升高并高于对照组[α角(°):72.66±2.82 vs62.63±5.85,CI值:3.19±1.27 vs 0.02±1.77,P<0.01],而在ISS≥16分组则明显下降低于对照组[α角(°):44.70±5.80 vs 62.63±5.85,CI值:-5.44±1.46 vs 0.02±1.77,P<0.01];最大宽度值(MA值)呈下降趋势,但ISS<16分组与ISS≥16分组MA值无差异性(P>0.05)。结论 TEG能更有效监测多发伤患者凝血功能障碍,指导临床治疗。

Objective To evaluate the role of thrombelastography （TEG） in monitoring coagulation disorders in polytrauma patients by comparing the test results of TEG and conventional coagulation test in patients with multiple trauma. Methods In a prospective study, 60 patients with multiple trauma were assigned into two groups according to their injury se- verity score （ISS） （ ISS 〈 16 group and ISS±〉 16 group with 30 patients in each group）. Another 30 non - polytrauma patients with normal coagulation function were assigned as control group. The venous blood was collected for conventional coagulation test and TEG, during which the blood routine parameters, D - dimer were analyzed and compared among three groups. Re- suits There was no significant difference in prothrombintime （PT） and international normalized ratio （INR） between the ISS 〈 16 group and control group （ P 〉 0. 05 ） in conventional coagulation test ; D - dimer gradually increased （ P 〈 0. 05 ） and platelet count （PLT） decreased （P 〈 0. 05 ）. In the thrombelastography, reaction time （ R time） and kinetics time （ K time） in the ISS 〈 16 group were lower than those in the control group [ R time（min） ： 4. 33 ±0. 51 vs 7.56 ± 1.52, K time（min） ： 1.08 ±0. 21 vs 2. 08 ±0. 51, P 〈0. 01 ] ,while in the ISS≥ 16 group, they were higher than those in the control group [ R time（min） ： 13.33 ± 1.89 vs 7.56 ± 1.52, K time（rain） ： 3.57 ±0. 67 vs 2. 08 ±0. 51, P 〈0. 01 ]. The clot formation rate （α angle） and coagulation index （CI） in the ISS 〈 16 group increased, significantly higher than those in the control group [αangle （ °） ： 72. 66 ± 2. 82 vs 62. 63 ± 5.85, CI ： 3.19 ± 1.27 vs 0. 02 ± 1.77, P 〈 0. 01 ], while in the ISS≥ 16 group, they significantly decreased, significantly lower than those in the control group [ a angle （°） ： 44.70 ± 5.80 vs 62.63 ± 5.85, CI ： - 5.44 ± 1.46 vs 0. 02 ± 1.77, P 〈 0. 01 ]. In spite of a decrease trend among three groups, there was no signifi- cant difference in maximum amplitude （MA） between the ISS 〈 16 group and the ISSS≥ 16 group （ P 〉 0. 05 ）. Conclusion TEG can monitor the change in coagulation disorders in patients with muhiple trauma more effectively and thus guides the clinical treatment.