血栓弹力图在脓毒症患者凝血功能障碍中的应用

Application of thromboelastography in sepsis in patients with coagulopathy

目的:对血栓弹力图在脓毒症患者凝血功能障碍中的应用进行分析。方法:选取2017-10-01—2018-06-30期间收治的67例脓毒症患者,将其分为DIC组和非DIC组,两组患者分别进行传统凝血指标(APTT、PT、TT、INR、FIB、DD、PLT等)与血栓弹力图检测,比较传统凝血指标与血栓弹力图在脓毒症凝血功能障碍患者中的改变,并进行回归分析。结果:与非DIC组比较,DIC组患者常规凝血检查中APTT、PT、TT均显著延长,INR、DD升高,PLT、FIB下降,差异有统计学意义(P<0.05);血栓弹力图指标中α角、MA、CI明显降低,R、K指标升高,差异有统计学意义;传统凝血指标与血栓弹力图检测的相关性分析表明,R与PT、INR、TT为中度正相关,K与FIB为中度负相关,α与FIB中度正相关,MA与PLT、FIB为中度正相关,CI与PT、INR为中度负相关,与FIB、PLT为中度正相关。在两种不同检测方法的结果与CDSS评分的相关性分析中,CDSS评分与APTT、PT、DD常规凝血检验结果呈现为中度正相关,与PLT呈高度负相关;与血栓弹力图中R、K为正相关,与α角、MA、CI呈负相关,且CDSS评分与血栓弹力图中的各指标相关性较好,其中与MA值具有高度相关性。结论:在脓毒症凝血功能障碍患者中应用血栓弹力图具有较好效果,可以更全面准确地提示患者凝血功能异常,具有较大早期诊断价值,值得推广。

Objective:To analyze the application of thromboelastography in sepsis patients with coagulopathy.Method:67 patients with septic coagulopathy who were admitted between October 1,2017 and June 30,2018 were enrolled.They were tested for traditional coagulation parameters and thromboelastogram(TEG).Changes in the disseminated intravascular coagulation(DIC)score were compared and regression analysis was performed.Result:Compared with the non dominant DIC patients,the indicators in the dominant DIC patients’ routine coagulation examination APTT、PT、TT were significantly extended,INR and DD were increased,PLT and FIB were significantly depressed.The indicators(α-angle、MA and CI)in the TEG examination of the dominant DIC patients’ were significantly lower,and other indicators were increased.Correlation analysis between traditional coagulation index and thromboelastography showed that R was positively moderately correlated with PT,INR and TT.K was negatively moderately correlated with FIB,αwas negatively moderately correlated with FIB,and MA was positively moderately correlated with PLT and FIB.CI was positively moderately correlated with FIB and PLT,and was negatively moderately correlated with PT and INR.The CDSS score was positively moderately correlated with the results of routine coagulation test of APTT,PT,DD,and highly negatively related to PLT.R,K were positively correlated with CDSS score and thromboelastogram,and negatively correlated with a-angle,MA and CI.Conclusion:The application of thromboelastography in patients with septic coagulopathy has a good effect,which can prompt patients with abnormal coagulation function,which has great early diagnostic value and is worthy of promotion.