危重患者血栓弹力图与常规凝血指标的对比研究

Comparison of thromboelastography and conventional coagulation tests in critically ill patients

目的探讨血栓弹力图(TEG)与常规凝血指标在重症监护病房(ICU)危重患者应用中的共性与差异。方法回顾分析2014年8月至2017年5月苏州市立医院本部ICU危重患者(86例)血栓弹力图的R值、K值、α-angle、最大振幅(MA),以及常规凝血指标中的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、血小板计数(PLT),计算中位数,进行Fisher精确概率检验及Kappa一致性分析。结果与正常参考范围相比,PT和APTT的中位数值增高,PLT的中位数值降低,而FIB和TEG的各参数的中位数值均在正常范围内。Fisher精确概率检验结果表明,R值与PT和APTT,K值与APTT、FIB和PLT,α-angle与PT、APIT、FIB和PLT,以及MA与FIB和PLT间的检验差异均具有统计学意义(P<0.05)。Kappa分析结果显示,常规凝血指标与TEG参数的一致性均较弱。结论 ICU内TEG与常规凝血检查结果一致性弱,两种方法不能相互替代。

Objective To investigate the commonness and differences between the parameters of thromboelastography （TEG） and those of conventional coagulation tests in critically ill patients from intensive care unit （ICU）.Methods A total of 86 critically ill patients admitted in ICU between August 2014 and May 2017 were enrolled in this study and retrospectively analyzed.The parameters of TEG, such as R and K values, α-angle, maximum amplitude（MA）, and the results of prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （FIB）, and platelet （PLT） count were calculated.Fisher exact test and Kappa identity test were performed.Results The medians of PT and APTT in the patients were higher, while that of PLT was lower than the normal ranges, and those of FIB and TEG were in the normal ranges.Fisher exact test indicated there were significant differences among R value with PT and APTT, K value with APTT, FIB and PLT,α-angle with PT, APTT, FIB and PLT, MA with FIB and PLT （P〈0.05）.Kappa identity test showed that the correlation was weak between the TEG parameters and the results of conventional coagulation test.Conclusion The consistency is weak between TEG and conventional coagulation test in the critically ill patients from ICU.So, the 2 methods can＆#39;t replace each other.