血栓弹力图在重症患者临床合理用血中的应用

Application of Thrombus Elastography in the Clinical Use of Blood in Severe Patients

目的:探索血栓弹力图在指导重症患者临床合理用血中的临床价值。方法:选择2017年9月-2018年7月于本院就诊并经临床医师申请血制品成分输注的115例诊断明确的住院重症患者,根据治疗中是否输血分为输血组(n=82)和非输血组(n=33)。所有患者输血前均行常规凝血检测和血栓弹力图(TEG)检测,分析常规凝血检测和血栓弹力图检测各参数的相关性,并评价对指导输血的临床价值。结果:输血组TEG、常规凝血指标的各参数与非输血组比较,差异均有统计学意义(P<0.05);Pearson相关性分析显示,凝血反应时间(R值)与活化部分凝血活酶时间(APTT)、凝血酶原时间(PT),最大血凝块强度(MA值)与纤维蛋白原(FIB)和血小板计数(PLT)呈正相关,血块生成时间(K值)与FIB、PLT呈负相关(P<0.05);血栓弹力图和常规凝血指标指导输血的输血率分别为81.71%(67/82)和95.12%(78/82),血栓弹力图输血率明显低于常规凝血指标指导输血率,且指导成分输血量亦低于常规凝血指标指导输血量,差异均有统计学意义(P<0.05);ROC曲线显示,应用MA值、K值及R值指导临床重症患者输血的灵敏度、特异度分别为91.23%和86.05%、89.02%和83.01%、92.68%和84.85%,Youden指数分别为≥0.773、≥0.720和≥0.775,较常规凝血检查各项参数诊断价值高,差异均有统计学意义(P<0.05)。结论:血栓弹力图与常规凝血试验各参数存在明显相关性,能在指导重症患者临床合理用血中提供重要指导依据,且MA、K值及R值的诊断价值较高。

Objective: To explore the clinical value of thrombus elastography in guiding the rational use of blood in severe patients. Method: A total of 115 severe patients treated in our hospital from September 2017 to July 2018 and who were applied for blood product infusion by a clinician were selected. Conventional coagulation test and TEG test were performed before blood transfusion in all patients. The correlation between conventional coagulation test and TEG parameters was analyzed, and the clinical value for guiding blood transfusion was evaluated. Result: Compared with the non-transfusion group, there were significant differences in the parameters of TEG and conventional coagulation test(P<0.05). Pearson correlation analysis showed that R was positively correlated with APTT and PT, MA was positively correlated with FIB and PLTs, and K was negatively correlated with FIB and PLT(P<0.05). The blood transfusion rates of TEG and conventional coagulation test guided blood transfusion were 81.71%(67/82) and 95.12%(78/82). The transfusion rate and the volume by TEG guiding were lower than conventional coagulation test guiding(P<0.05). ROC curve showed that the sensitivity and specificity of blood transfusion guided by MA, K and R were 91.23% and 86.05%, 89.02% and 83.01%, 92.68% and 84.85%, and the Youden index were ≥0.773, ≥0.720 and ≥0.775.The diagnostic values of MA, K and R were higher than other parameters of conventional coagulation test(P<0.05). Conclusion: TEG is significantly correlated with the parameters of conventional coagulation test, and can provide important guidance for guiding the clinical use of blood in patients with severe diseases, and the diagnosis value of MA, K and R are relatively higher than others.