血栓弹力图指导下输血治疗对创伤后大出血患者血钾、凝血指标及预后的影响

Effects of thromboelastography guided blood transfusion on blood potassium,coagulation parameters and prognosis in patients with post-traumatic massive hemorrhage

目的分析血栓弹力图指导下输血治疗对创伤后大出血患者血钾、凝血指标及预后的影响。方法回顾性分析溧阳市人民医院2018年3月至2021年2月创伤后大出血患者73例临床资料,按照是否行血栓弹力图(TEG)检测分为TEG输血指导组(A组)和常规凝血指标指导组(B组)。通过重复测量方差分析及事后LSD-t检验观察两组患者各时点血钾、凝血指标与预后情况。结果A组输血量明显低于B组(P<0.05);输血前[(3.94±0.85)mmol/L比(3.98±0.71)mmol/L]、输血后第1天[(4.33±0.48)mmol/L比(4.57±0.73)mmol/L]两组患者血钾水平比较差异有统计学意义(P<0.05);输血后第1~3天A组凝血酶原(PT)、活化部分凝血活酶时间(APTT)指标明显低于B组[PT:(14.30±1.43)s比(16.25±1.74)s、(14.41±1.55)s比(16.27±1.48)s、(14.73±1.50)s比(16.30±1.45)s,APTT:(32.3±3.6)s比(36.7±3.5)s、(32.6±3.4)s比(36.8±3.6)s、(32.2±3.2)s比(36.3±3.3)s],差异有统计学意义(P<0.05);两组治疗前上述指标明显高于治疗后各时点指标(P<0.05)。A组止血总有效率高于B组[97.37%(37/38)比80.00%(28/35)](P<0.05)。结论创伤后出血患者采用血栓弹力图指导下可以减少总输血量,更快纠正血钾异常及凝血指标紊乱,同时具有较好的止血效果。

Objective Analyze the influence of blood transfusion therapy under the guidance of thromboelastography on the blood potassium and coagulation indicators and prognosis of patients with post-traumatic hemorrhage.Methods The clinical data of 73 patients with post-traumatic hemorrhage in Liyang People′s Hospital from March 2018 to February 2021 were retrospectively analyzed.Among them,TEG blood transfusion guidance group(group A)and conventional coagulation indicator guidance group(group B)were divided according to whether TEG test was performed.Repeated measurement analysis of variance and post LSD-t test were used to observe serum potassium,coagulation indexes and prognosis of 2 groups at each time point.Results The amount of various drugs used in group A was significantly lower than that in group B(P<0.05).Comparison of serum potassium levels between the two groups before transfusion:(3.94±0.85)mmol/L vs.(3.98±0.71)mmol/L;and on the first day after transfusion:(4.33±0.48)mmol/L vs.(4.57±0.73)mmol/L,there were statistically significant(P<0.05);on day one.day two and day three after blood transfusion,the indexes of PT and APTT in group A were significantly lower than those in group B:PT:(14.30±1.43)s vs.(16.25±1.74)s,(14.41±1.55)s vs.(16.27±1.48)s,(14.73±1.50)s vs.(16.30±1.45)s;APTT:(32.3±3.6)s vs.(36.7±3.5)s,(32.6±3.4)s vs.(36.8±3.6)s,(32.2±3.2)s vs.(36.3±3.3)s;the above indexes of the two groups before treatment were significantly higher than those at each time point after treatment(P<0.05).The total effective rate of hemostasis in group A was higher than that in group B:97.37%(37/38)vs.80.00%(28/35),P<0.05.Conclusions Patients with post-traumatic hemorrhage can be recovered by blood transfusion under the guidance of thromboelastography,and the disorder of blood coagulation indicators can be restored,and at the same time,it has a better hemostatic effect.