快速血栓弹力图在严重创伤患者救治中的应用

The application of rapid-thromboelastography in the treatment of severe trauma patients

目的探讨快速血栓弹力图凝血激活时间(ACT)与普通血栓弹力图凝血反应时间(R)在急诊严重创伤患者救治中的应用与差异。方法选择重庆市急救医疗中心2016年7月至2017年6月收治的61例严重创伤患者[创伤严重度评分(ISS评分)≥16分]为研究对象,ISS<25分(A组)23例,ISS≥25分(B组)38例。对其同步进行快速血栓弹力图和普通血栓弹力图检测,记录ACT值、R值、出血量、用血量,用SPSS19.0对数据进行统计分析。结果 ACT值与ISS评分、出血量和用血量的相关系数r分别为:0.293,0.343,0.554(P<0.05);R值与ISS评分、出血量和输血量无相关性。死亡组患者的ACT显著高于生存组,差异有统计学意义(P<0.05);两组患者R值比较,差异无统计学意义(P>0.05)。B组患者的ACT显著高于A组患者,差异有统计学意义(P<0.05);两组的R值比较,差异无统计学意义(P>0.05)。结论快速血栓弹力图ACT值对急诊创伤患者的伤情判断和快速科学救治具有重大意义。

Objective To explore the application value of rapid thromboelastography activated clotting time（ACT）of whole blood and the general thromboelastography react time（R）in the emergency treatment of severe trauma patients.Methods A total of 61 cases of severe trauma patients[index-injury severity score（ISS）scoring higher than 16 points]from July 2016 to June 2017 were selected from Chongqing Emergency Medical Center,they were divided into group A（23 cases,ISS score lower than 25）and group B（38 cases,ISS score higher than 25）.Rapid-thromboelastography and ordinary thromboelastography were tested,and the ACT value,R value,the blood loss,the blood transfusion volume were recorded.Date were analyzed by SPSS19.0.Results The correlation coefficients of ACT value with ISS score,blood loss and blood transfusion volume were0.293,0.343,0.554,respectively（P〈0.05）.R value was not correlated with ISS score,blood loss and blood transfusion volume.ACT of patients who died later was significantly higher than that of patients who survived（P〈0.05）.Difference of R value of two groups had no statistical significance（P〈0.05）.ACT of group B was significantly higher than that of group A（P〈0.05）,and difference of R value of two groups had no statistical significance（P〈0.05）.Conclusion The ACT value of rapid-thromboelastography is of great significance for the diagnosis and rapid scientific treatment of emergency trauma patients.