急重症患者血栓弹力图与传统凝血检查对比研究  

The comparative study between thromboelastography and conventional coagulation tests in critically ill patients of emergency department

作　　者：胡贵锋[1] 李俊杰[1] 尹文[1] 

机构地区：[1]第四军医大学西京医院急诊科,西安710032

出　　处：《中华急诊医学杂志》2017年第9期1043-1049,共7页Chinese Journal of Emergency Medicine

基　　金：西京医院学科助推计划（XJZT14D10）;军队重大课题子项目（AWS14C003-01）;陕西省自然科学基础研究计划项目（2014JM4186）;青年科学基金项目（81500492）

摘　　要：目的探讨急重症患者血栓弹力图（thromboelastography，TEG）与传统凝血检查（conventional coagulation tests，CCTs）相关性及差异，为TEG临床应用提供参考。方法前瞻性收集2015年8月至2016年9月西京医院急诊科急重症成人患者TEG和CCTs资料，回顾性对比分析。对临床意义相似的参数进行相关性分析，探讨各参数意义；应用ROC曲线分析凝血反应时间（R）诊断凝血酶原时间（PT）或活化部分凝血酶时间（APTF）异常的灵敏度、特异度，比较R、PT、APTT反映凝血因子异常的灵敏度；分层统计血小板（PLT）计数、纤维蛋白原（FIB）浓度异常时凝固角（俚）、血栓最大幅度（MA）的变化，了解仪和MA反映PLT、FIB异常的能力；综合比较TEG和CCTs结果，探讨两者对凝血整体状况的反映能力；比较创伤患者TEG和CCTs预测血制品输注率。采用配对四格表资料χ^2检验进行检验，以P〈0．05为差异有统计学意义。结果（1）R与PT、APTr呈弱相关；MA与FIB、PLT呈中度相关；α、K均与PLT中度相关，与FIB弱相关；TEG各参数中，R与MA不相关，R与K、α中度相关，K与α、MA及α与MA均高度相关。（2）以R〉10min诊断PT〉15．1s，灵敏度为32％（95％CI：0．20—0．47），特异度为90％（95％CI：0．84～0．94）；诊断APTT〉41．8s，灵敏度为39％，（95％CI：0．25—0．54），特异度为91％（95％CI：0．85—0．95）。（3）MA或α反映单纯PLT计数、FIB浓度异常的灵敏度不高；（4）TEG能发现常规凝血检查不能检测到的异常。（5）TEG指导的复苏能够减少创伤患者血浆的输注率。结论TEG和常规凝血检查整体相关性一般，R鉴别凝血因子低下的灵敏度低于PT、APTT；TEG主要反映PLT、FIB功能异常，对数量的轻度变化不敏感，能发现CCTs不能检测到的异常，其指导复苏有助于减少创伤患者血浆输注率。TEG较CCTs有一定的优越性，但是Objective To explore the correlation and difference between thromboelastography （TEG） and conventional coagulation tests （CCTs） in critically ill patients of emergency department, so as to provide valuable information for TEG clinical application. Methods TEG and CCTs data of critically ill patients admitted from August 2015 to September 2016 in emergency department of Xijing Hospital were prospectively collected and retrospectively analyzed. The correlational analyses of analogue parameters of TEG and CCTs were carried out to investigate their clinical significance. ROC curve was used to explore the sensitivity and specificity of R for diagnosis of abnormal PT and APTT. Then comparisons of sensitivity of detecting abnormalities of clotting factors among R, PT and APTr were made. The changes of α and MA in patients with abnormal platelet count or fibrinogen concentration were respectively counted so as to evaluate the ability of α and MA to reflect abnormal platelet count or fibrinogen concentration. The results of TEG and CCTs were comprehensively analyzed to find out the capability of TEG and CCTs in reflecting the overall blood coagulation status. The differece in blood transfusion rate was compared between TEG and CCTs in trauma patients. The chi-square test of matched fourfold table was used to test the significance and there was statistical significance when P 〈 0. 05. Results （ 1 ） R correlated weakly with PT and APTT, MA correlated moderately with FIB and PLT; K and α angle correlated moderately with PLT and weakly with FIB. For the TEG parameter, there was no correlation between R and MA. R correlated moderately with K, α, and K correlated strongly with α angle, MA, and ct correlated strongly with MA. （2） For detecting PT 〉15.1 s, the sensitivity of R （ 〉 10 min） was 32% （95% CI： 0. 20 -0.47） and specificity was 90% （95% CI： 0. 84 -0. 94）. For detecting APTF 〉41.8 s, the sensitivity of R （ 〉 10 min） was 39% （95% CI： 0. 25 -0. 54） and specificity wa

关 键 词：急重症 血栓弹力图 常规凝血检查 对比研究 

分 类 号：R459.7[医药卫生—急诊医学]