血栓弹力图在重症肺炎患者凝血管理中的应用

Application of thromboelastography in coagulation management of patients conformed with severe pneumonia

目的 探讨血栓弹力图(Thrombelastography,TEG)在重症肺炎患者凝血管理中的临床应用价值。方法 收集本院5例重症肺炎患者,采用血栓弹力图技术对其进行凝血功能的动态监测,分析治疗期内血栓弹力图各凝血相关实验参数的变化规律及其与病情进展的关系,并随访18个月,根据其预后分为存活组和死亡组。结果 重症肺炎患者重型期凝血功能:CI、R、MA、K、Angle、Ly30的实验数值总体处于正常凝血状态;重症肺炎患者危重型期凝血功能:CI、MA、Angle的实验数值低于参考值,R、K的实验数值高于参考值,Ly30的实验数值在参考值范围内,总体凝血功能偏低凝或凝血危象状态,其中存活4例,死亡1例。结论 重症肺炎患者的重型期与危重型期凝血功能存在较大差异,临床对重症肺炎患者开展血栓弹力图动态监测,有助于其病情进程的判断并有望改善临床预后。

Objective To explore the clinical application value of thromboelastography(TEG) in coagulation management of patients with severe pneumonia.Methods Five case of patients with severe pneumonia were collected from the First Affiliated Hospital of Wenzhou Medical University.Coagulation function was dynamically monitored using thromboelastography technology.The changes of the coagulation-related experimental parameters of the thromboelastography and their relationship with the progression of disease were also investigated during the treatment period.The patients were monitored by 18 months’ follow-up,and were subsequently divided into survival group and death group according to their prognoses.Results The coagulation parameters of CI,R,MA,K,Angle,Ly30 were normal in general during the severe period in patients with severe pneumonia.By contrast,the values of CI,MA,and Angle were lower and the R and K values were higher than the reference values during the critical severe period,while values of Ly30 were within the reference range,which exhibited a state of hypocoagulation or coagulation crisis,the survival group(4 case) and the death group(1 case).Conclusion There is a significant difference of coagulation function between the severe stage and the critically sever stage in patients with severe pneumonia.Dynamic monitoring of thromboelastogram in patients with severe pneumonia is helpful to judge the progress of the disease and improve the clinical prognosis.