血栓弹力图与危重新生儿病情严重程度的关系及对凝血功能异常的预测效能研究

Study on predictive efficacy of the thromboelastogram on abnormal coagulation in critically ill neonates

目的探讨血栓弹力图与危重新生儿病情严重程度的关系及对凝血功能异常的预测效能。方法选择我院自2021年6月至2022年12月收治的160例危重新生儿作为研究对象,根据新生儿危重病例评分(NCIS)进行分组,其中危重组86例(NCIS评分70~90分)和极危重组74例(NCIS评分<70分)。比较两组血栓弹力图参数[反应时间(R时间)、凝血时间(K时间)、α角、血栓最大弹力度(MA)、纤活指数(EPL)、凝血幅度下降速率(LY30)],使用Pearson相关性分析血栓弹力图参数与NCIS评分的关系,分析凝血功能异常情况,通过受试者工作特征曲线(ROC)下面积(AUC)评价血栓弹力图参数对凝血功能异常的预测效能。结果极危重组R时间、K时间均短于危重组,α角、MA、EPL、LY30均大于危重组,差异均有统计学意义(P<0.05);经Pearson相关性分析,危重新生儿NCIS评分与R时间、K时间呈正相关(P<0.05),与α角、MA、EPL、LY30呈负相关(P<0.05);在160例危重新生儿中,发生凝血功能异常84例,占52.50%;经多因素Logistic回归分析,R时间、LY30均是危重新生儿发生凝血功能异常的独立预测因素(P<0.05);经ROC曲线分析,R时间联合LY30预测危重新生儿发生凝血功能异常的AUC为0.912。结论血栓弹力图与危重新生儿病情严重程度的关系密切,R时间联合LY30预测凝血功能异常的效能较好。

Objective To investigate the relationship between thromboelastogram and severity of disease in critically ill neonates and its predictive efficacy for coagulation dysfunction.Methods A total of 160 critically ill neonates admitted to our hospital from June 2021 to December 2022 were selected as the study subjects.According to the neonatal critical case Score(NCIS),there were 86 cases in the critical group(NCIS score:70 to 90 points)and 74 cases in the extremely critical group(NCIS score:<70 points).The parameters of thrombolysis diagram[reaction time(R time),coagulation time(K time),αAngle,maximum thrombolysis force(MA),fibroactivity index(EPL)and decreasing rate of coagulation amplitude(LY30)]were compared between the two groups.Pearson correlation analysis was used to analyze the relationship between thrombolysis diagram parameters and NCIS score to analyze the abnormal coagulation function.The area under receiver operating characteristic curve(AUC)was used to evaluate the predictive efficacy of thromboelastogram parameters for coagulation abnormalities.Results R time and K time were shorter in critical group than in critical group,αAngle,MA,EPL and LY30 were higher than in critical group,the differences were statistically significant(P<0.05).According to Pearson correlation analysis,NCIS score was positively correlated with R time and K time(P<0.05),but negatively correlated withαAngle,MA,EPL and LY30(P<0.05).Among 160 critically ill neonates,84(52.50%)had coagulation dysfunction.Multivariate Logistic regression analysis showed that R time and LY30 were independent predictors of coagulation dysfunction in critically ill neonates(P<0.05).According to ROC curve analysis,the AUC of R time combined with LY30 predicting the occurrence of coagulation dysfunction in critically ill newborns was 0.912.Conclusion Thrombolysis diagram is closely related to the severity of the condition of critically ill neonates,R time combined with LY30 has good efficacy in predicting coagulation dysfunction,which is worthy of clinical application.