创伤合并弥散性血管内凝血患者血栓弹力图诊断标准的临床研究  

Clinical study on the diagnostic value of maximum amplitude for the heatstroke with DIC

作　　者：曾庆波[1] 宋景春[1] 林青伟 胡炜[1] 邓星平[1] 张昕 陈涛 宋晓敏[1] ZENG Qing-bo;SONG Jing-chun;LIN Qing-wei;HU Wei;DENG Xing-ping;ZHANG Xin;CHEN Tao;SONG Xiao-min(Intensive Care Unit,the 94th Hospital of PLA,Nanchang 330002,Jiangxi,China)

机构地区：[1]解放军第九四医院重症医学科,南昌330002

出　　处：《东南国防医药》2018年第5期471-475,共5页Military Medical Journal of Southeast China

基　　金：江西省科技计划项目(2014BBG70057);江西省卫生计生委科技计划课题(20163016)

摘　　要：目的研究创伤合并弥散性血管内凝血(DIC)血栓弹力图(TEG)诊断标准的临床价值。方法回顾性分析2015年9月至2017年12月解放军第九四医院重症医学科收治的128例创伤患者,根据预后分为生存组(n=116)与死亡组(n=12),比较2组患者入院2h的TEG和常规凝血指标如血浆凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶原时间(TT)、纤维蛋白降解产物(FDP)和D-二聚体(D-Dimer),比较国际血栓与止血学会诊断标准与TEG诊断DIC发病率和病死率的相关性。结果与生存组K值[3.0(2.1~4.5) min]相比,死亡组K值[5.0(2.1~8.7) min]明显延长差异有统计学意义(P<0. 05);生存组α角[51.6°(40. 8~59.6)°]、血块最大强度(MA)[(51.82±13.07) mm]与凝血指数(CI)值[-2.9(-6.3^-0. 7)]均分别显著高于死亡组α角[39.5°(28.2~55.6)°]、MA值[(37.35±17.49) mm]和CI值[-6.85(-11.45^-2.73)]均明显降低(P<0. 05)。符合TEG-DIC诊断标准的DIC患者发病率较ISTH-DIC诊断标准升高(P=0. 048); TEG评分与病死率呈正相关(r2=0. 9423,P=0. 006)。结论 TEG可用于诊断创伤合并DIC和判断预后。Objective To investigate the clinical value of diagnostic criteria for thrombelastography in the diagnosis of trauma with DIC. Methods A retrospective analysis of 128 trauma patients,which were selected from the 94th Hospital of PLA from Sep 2015 to Dec 2017. The general information and laboratory tests results of the patients within 2 hours after admission that containing prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin time, plasma fibrin degradation products, D-Dimer and the TEG parameters were collected. The patients were divided into survival group（116 cases） and death group（12 cases） according to prognosis. The results of coagulation tests and thromboelastography were compared. The TEG-DIC and ISTH-DIC criteria were also compared. Besides, the relationship between TEG score and mortality were investigated. Results Compared with the K value[3.0（2.1- 4.5 ）min] of survival group,the K value[5.0（2.1-8.7）min]of death group were significantly higher （ P 〈0.05）. Compared with the α angle [51.6（40.8-59.6）°], MA value（51.82±13.07mm）and CI value[-2.9（-6.3--0.7）]of survival group, the α angle [39.5（28.2-55.6）°], MA value （37.35±17.49mm） and CI value [-6.85（-11.45--2.73）] of death group were significantly lower （ P 〈0.05）.Compared with the R value[7.2（5.2-8.8）min] and of survival group,the R value[6.9（ 4.1- 8.9）min] of death group were lower （ P 〉0.05）. Compared with ISTH-DIC criteria, the TEG-DIC criteria was capable of diagnosing the more numbers and a high severity of patients （ P =0.048）. There was positive correlation between TEG score and mortality （ r 2=0.9423, P =0.006） according to linear regression analysis. Conclusion TEG scores can diagnose trauma with overt DIC more sensitively compared with ISTH-DIC scores.

关 键 词：创伤 血栓弹力图 弥散性血管内凝血 诊断 

分 类 号：R641[医药卫生—外科学] R554.8[医药卫生—临床医学]