危重烧伤患者血栓弹力图、凝血指标及血小板变化的临床意义  

Thrombelastogram,coagulation index and blood platelets in severely burned patients

作　　者：沈观樵[1] 张奇[1] 童海江[1] 

机构地区：[1]绍兴第二医院检验中心,312000

出　　处：《浙江医学》2015年第19期1617-1620,共4页Zhejiang Medical Journal

摘　　要：目的探讨危重烧伤患者血栓弹力图、凝血指标及血小板变化的临床意义。方法回顾性分析烧伤科收治的55例危重烧伤患者,于烧伤后3d内(渗出期)检测血栓弹力图(TEG)、凝血指标和血小板(PLT)水平,并选择34例健康体检者作为健康对照组。55例危重烧伤患者中29例于术前动态监测TEG、凝血指标和PLT变化。结果危重烧伤患者渗出期与健康对照组比较,R值、K值及PLT明显减少,α角、CI值明显增大,均有统计学差异(均P<0.05)。危重烧伤患者术前与渗出期比较,R值、MA值、Fb、PLT显著增高,TT显著缩短,均有统计学差异(均P<0.05)。R值与APTT呈正相关;K值与Fb、PLT呈负相关;α角与Fb、PLT呈正相关;MA值与TT呈负相关,与Fb、PLT呈正相关;CI值与APTT呈负相关,与Fb呈正相关(均P<0.05)。结论危重烧伤患者凝血功能常出现明显异常,TEG与凝血指标、PLT水平存在相关性,检测3者可起到互补作用。对于全面评估危重烧伤患者凝血功能,判断出血风险、指导输血有重要的意义。Objective To investigate the clinical significance of changes in thrombelastogram, coagulation index and blood platelets of severely burned patients. Methods Fifty five patients with severe burn injury underwent examinations of thrombelastography （TEG）, coagulation index and blood platelet （PLT） in 3 days after burn injury （exudation phase）, among whom 29 patients were also examined for above indexes preoperatively; while 34 healthy subjects served as controls. Results Compared to control group, the R, K values and PLT levels in burned patients of exudation phase were markedly decreased, and the α angle and CI were significantly higher （all P〈0.05）. Compared to preoperation, the R, MA values, fibrinogen （Fb）, and PLT of burned patients in exudation phase were significantly higher, and the thrombin time （TT） was significantly lower （all P〈0.05）. Additionally, R value was positively correlated with activated partial thromboplastin time （APTT） and negatively correlated with blood Fb and PLT levels; while α-angle was positively correlated with Fb and PLT; MA value was negatively correlated with TT and positively correlated with Fb and PLT; CI was negatively correlated with APTT and positively correlated with Fb. Conclusion Examinations of thrombelastography, coagulation index and blood platelets levels may provide useful information for evaluation of disease severity and guidance of treatment in patients with severe burn injury.

关 键 词：烧伤 血栓弹力图 凝血功能 血小板 相关性 

分 类 号：R644[医药卫生—外科学]