贵州医科大学学报

2019, v.44;No.231(12) 1448-1452

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血栓弹力图参数对创伤急症患者的临床诊断价值
The Diagnostic Value of Thromboelastance Parameters in Patients with Traumatic Emergency

张健;马莉;刘慧玲;陈晔;殷红;
ZHANG Jian;MA Li;LIU Huiling;CHEN Ye;YIN Hong;Department of Clinical Laboratory, Changzhou Cancer Hospital, Suzhou University;Central Laboratory, the Affiliated Hospital of Guizhou Medical University;

摘要(Abstract):

目的:探讨血栓弹力图(TEG)对创伤急症患者的临床诊断价值。方法:53例创伤急症患者分为存活组(n=42)和死亡组(n=11),采用急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分系统评估病情,患者入院后24 h内取血检查传统凝血功能(CCTs)指标凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)及D-二聚体和血小板计数(PLT),同时检测血栓弹力图(TEG)参数包括凝血反应时间(R)、全血凝固时间(K)、凝固角(α角)、血栓最大振幅(MA)及凝血指数(CI),对TEG与CCTs各参数进行相关分析。结果:死亡组患者APACHEⅡ评分、PT、APTT、R及K值明显高于存活组(P<0.01),FIB、α角、MA及CI值低于存活组(P<0.05),但死亡组患者PLT、D-二聚体与存活组的差异均无统计学意义(P>0.05);创伤急症患者R与PT、APTT中度正相关(P<0.01),CI与PT、APTT中度负相关(P<0.01),K与FIB中度负相关(P<0.01),CI、α角及MA均与FIB中度正相关(P<0.01)。结论:TEG不仅能评估创伤急症患者凝血各参数的数量异常,而且可以进行凝血质量的评估。
Objective: To explore the diagnostic value of thromboelastography(TEG) in patients with traumatic emergency. Methods: Fifty-three patients with traumatic emergency were divided into survival group(n=42) and death group(n=11). The scoring system of acute physiological and chronic health assessment Ⅱ(APACHEⅡ) was used to evaluate the status of patients.Traditional coagulation function tests(CCTs) were measured within 24 hours after admission, including thrombin time(PT), activated partial thromboplastin time(APTT), fibrinogen(FIB), D-dimer, and platelet count(PLT). In addition, we also detected the thromboelastogram(TEG) parameters including coagulation reaction time(R), whole blood coagulation time(K), coagulation angle(α angle), maximum thrombus amplitude(MA), and coagulation index(CI). Furthermore, the correlation of TEG with CCTs parameters were analyzed. Results: The APACHEⅡ score, PT, APTT, R, and K values of the death group were significantly higher than those of the survival group(P<0.01),while the FIB, α angle, MA, and CI values were lower than those of the survival group(P<0.05).The differences of PLT, D-dimer between two groups were not statistically significant(P>0.05). Moreover, R values were positively correlated with PT and APTT(P<0.01), while CI values were negatively correlated with PT and APTT.(P<0.01). In addition, K values were negatively associated with FIB(P<0.01), CI and α angles, while MA values were all positively correlated with FIB(P<0.01). Conclusion: TEG can be used not only to assess the abnormal quantity of various parameters of coagulation in patients with traumatic emergency, but also to evaluate the quality of coagulation.

关键词(KeyWords): 创伤急症;凝血功能障碍;APACHEⅡ评分;传统凝血功能检查;诊断价值
traumatic emergency;coagulation dysfunction;APACHEⅡ score;traditional coagulation function test;diagnostic value

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基金项目(Foundation): 贵州省科技厅社会发展攻关项目[黔科合LG字(2011)034]

作者(Author): 张健;马莉;刘慧玲;陈晔;殷红;
ZHANG Jian;MA Li;LIU Huiling;CHEN Ye;YIN Hong;Department of Clinical Laboratory, Changzhou Cancer Hospital, Suzhou University;Central Laboratory, the Affiliated Hospital of Guizhou Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2019.12.016

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