血栓弹力图联合凝血四项及血小板计数用于指导危重症患者血小板输注治疗的临床研究

The clinical study of thromboelas-tography combined with coagulation four items and platelet count to guide platelet transfusion in critically ill patients

目的 探讨血栓弹力图、凝血四项、血小板计数等指标联合使用对指导危重症患者血小板输注的临床价值。方法 选取2020年1月至2022年1月本院ICU病房188例危重症患者为研究对象,按照是否存在出血症状分为研究组(n=89)和对照组(n=99)。采用独立样本t检验进行2组数据间比较分析,采用Spearman对TEG、凝血四项、血小板计数间关系进行相关性分析,采用二元Logistic回归分析预测危重症患者出血影响因素,采用ROC曲线分析以上指标对血小板输注的指导价值。结果 1)研究组K值、PT值明显高于对照组,且大于正常范围;而Angle值、MA值、CI值、FIB值、PLT计数明显低于对照组,其中MA值、CI值、PLT计数低于正常范围。2)TEG、凝血四项、血小板计数之间存在相关性,TEG参数中的MA值与CI值均与血小板计数呈正相关,R值与K值与血小板计数呈负相关;R值与PT、APTT呈正相关,CI值与PT、APTT呈负相关,K值与PT呈正相关,Angle值、MA值与PT呈负相关。3)经二元Logistic回归分析显示,MA值减少、血小板计数减少是预测危重症患者出血的独立危险因素(P<0.05)。4)ROC曲线分析显示,Angle值、MA值、CI值、FIB值、PLT计数对应的曲线下面积为0.866、0.932、0.9、0.838、0.987,以上指标对应的P值均<0.05。灵敏度以PLT计数最高,FIB值最低;特异性以MA值最高,Angle值最低。相较于单独指标,联合指标(K值、MA值、CI值、PT值、PLT计数)曲线下面积为0.995(P<0.05),约登指数0.944,敏感度100%,特异性93.3%,均高于单独指标。结论 血栓弹力图、凝血四项、血小板计数联合使用可准确用于预测危重症患者出血风险和指导临床血小板输注,K值、MA值、CI值、PT值、PLT计数等指标联合使用在灵敏度及特异性上要明显优于以上任意单独指标,具有良好的临床指导价值。

Objective To explore the clinical value of thromboelas-tography,coagulation four items and platelet count in guiding platelet transfusion in critically ill patients.Methods A total of 188 critically ill patients in Intensive Care Unit of our hospital from January 2020 to January 2022 were selected as subjects,and were divided into study group(n=89) and the control(n=99) according to the presence of bleeding symptoms.T-test was used for comparative analysis between the two groups.Spearman was used to analyze the correlation between TEG,coagulation four items and platelet count,and binary Logistic regression analysis was used to predict the influential factors of bleeding in critically ill patients,ROC curve was used to analyze the guiding value of the above-mentioned indexes for platelet transfusion.Results 1) K and PT values in the study group,above the normal range,were significantly higher than those in the control,while the Angle value,MA value,CI value,FIB value and platelet count were significantly lower than those of the control,among which MA value,CI value and platelet count were below the normal range.2) TEG,coagulation four items and platelet count were correlated.MA and CI values were positively correlated with platelet count,instead,R and K values were negatively correlated.R value was positively correlated with PT and APTT,CI value,on the contrary,was negatively correlated,K value was positively correlated with PT,while Angle value and MA value were negatively correlated.3) Binary Logistic regression analysis showed that decreased MA value and decreased platelet count were independent risk factors for predicting bleeding in critically ill patients(P<0.05).4) ROC curve analysis showed that the areas under ROC curve corresponding to Angle value,MA value,CI value,FIB value and platelet count were 0.866,0.932,0.9,0.838 and 0.987(P<0.05).The sensitivity was highest in platelet count and lowest in FIB.The specificity was highest in MA and lowest in Angle.Compared with the single index,the area under the curve of the combined index(K value,MA value,CI value,PT value and platelet count) was 0.995(P<0.05),Yoden index 0.944,sensitivity 100%,specificity 93.3%,all higher than the individual index.Conclusion Thromboelas-tography combined with coagulation four items and platelet count can be used to accurately predict the critically ill patients with bleeding risk.To guide clinical platelets transfusion,the combined use of indexes,including K value,MA,CI value,PT and platelet count,is superior to separate use of them as the former showed better sensitivity and specificity,demonstrating a good clinical value.