血栓弹力图和凝血功能指标在严重创伤性患者中的变化及临床意义

Changes and clinical significance of thromboelastogram and coagulation function indexes in severely traumatic patients

目的分析严重创伤性患者的血栓弹力图和凝血功能指标水平变化的临床意义,为患者的临床诊疗提供参考。方法选择空军军医大学第二附属医院2017年9月至2018年9月收治的严重创伤患者101例作为研究对象。其中52例凝血机制障碍患者为观察组,49例无凝血机制障碍患者为对照组。比较两组患者的血栓弹力图、凝血功能指标水平以及治疗后并发症发生情况。结果观察组患者的凝血块形成时间和反应时间分别为(2.8±0.6)min、(7.5±1.8)min,明显长于对照组的(2.2±0.4)min、(6.3±1.7)min,差异均有统计学意义(P<0.05);观察组患者血栓弹力图显示最大振幅(54.9±6.1)min、凝血块形成速率(54.5±7.4)°,明显低于对照组的(59.4±7.6)min、(58.9±7.2)°,差异均有统计学意义(P<0.05);观察组患者的血浆凝血酶原时间(41.2±6.8)s、活化部分凝血活酶时间(15.7±2.2)s、凝血酶时间(23.2±3.6)s,明显长于对照组的(35.5±6.1)s、(14.6±2.1)s、(21.1±3.5)s,差异均有统计学意义(P<0.05);观察组患者的纤维蛋白原为(2.2±1.3)g/L,明显低于对照组的(2.6±1.4)g/L,差异有统计学意义(P<0.05);观察组患者的并发症总发生率为40.4%,明显高于对照组的18.4%,差异有统计学意义(P<0.05)。结论血栓弹力图以及凝血功能指标检测有助于监测严重创伤性患者凝血功能、减少创伤性凝血机制障碍及并发症的发生率。

Objective To analyze the clinical significance of changes in the thromboelastogram and coagulation function index of severely traumatic patients,and provide references for clinical diagnosis and treatment of patients.Methods A total of 101 patients with severe trauma admitted to the Second Affiliated Hospital of Air Force Medical University of PLA from September 2017 to September 2018 were selected as the research objects.Among them,52 patients with coagulation disorders were enrolled as the observation group,and 49 patients without coagulation disorders were enrolled as the control group.The thromboelastogram,levels of coagulation function index,and the occurrence of complications after treatment were compared between the two groups.Results The clot formation time and reaction time of the observation group were(2.8±0.6)min and(7.5±1.8)min,respectively,which were significantly longer than(2.2±0.4)min and(6.3±1.7)min in the control group(P<0.05);the thromboelastogram of the observation group showed that the maximum amplitude was(54.9±6.1)min and the clot formation rate was(54.5±7.4)°,which was significantly lower than(59.4±7.6)min,(58.9±7.2)°in the control group(P<0.05);the plasma prothrombin time,activated partial thromboplastin time,thrombin time of the observation group were(41.2±6.8)s,(15.7±2.2)s,(23.2±3.6)s,significantly longer than(35.5±6.1)s,(14.6±2.1)s,(21.1±3.5)s in the control group(P<0.05);the fiber protein source in the observation group was(2.2±1.3)g/L,which was significantly lower than(2.6±1.4)g/L in the control group(P<0.05);the total incidence of complications in the observation group was 40.4%,significantly higher than 18.4%of the control group(P<0.05).Conclusion Thromboelastography and coagulation function index detection can help monitor the coagulation function of severely traumatic patients and reduce the incidence of traumatic coagulation mechanism disorders and complications.