血栓弹力图对骨科创伤患者输血治疗的诊断价值  

The value of thromboelastography in the diagnosis of blood transfusion in orthopedic trauma patients

作　　者：李佳真 李海彬[2] 林朝[2] 金妍[2] 张俏忻[3] 张苏伟[2] LI Jiazhen;LI Haibin;LIN Zhao;JIN Yan;ZHANG Qiaoxin;ZHANG Suwei(Shantou University Medical College,Shantou 515041,China;Department of Clinical Laboratory,Shantou Central Hospital,Shantou 515041,China;Department of Clinical Laboratory Medicine,the First Affiliated Hospital of Shantou University Medical College,Shantou 515041,China)

机构地区：[1]汕头大学医学院,广东汕头515041 [2]汕头市中心医院检验科,广东汕头515041 [3]汕头大学医学院第一附属医院检验科,广东汕头515041

出　　处：《汕头大学医学院学报》2020年第2期105-108,共4页Journal of Shantou University Medical College

基　　金：广东省医学科研基金(B2019240)。

摘　　要：目的:探讨血栓弹力图(TEG)在指导骨外科创伤输血治疗的诊断价值。方法:回顾性分析2018年12月—2019年8月在汕头市中心医院骨外科接受常规凝血和TEG检测的创伤患者122例,根据患者术后住院期间是否进行输血治疗分为输血组(81例)和未输血组(41例)。进行TEG和常规凝血检测的相关性分析,TEG和常规凝血检测各指标的预测效能采用受试者工作特征曲线分析。结果:常规凝血检测参数与TEG参数有一定相关性,其中纤维蛋白原浓度与凝块形成时间为负相关(r=-0.580),与凝固角(Angle)、血栓最大振幅(MA)、凝血指数(CI)均为正相关(r=0.620、0.741、0.579)。TEG中Angle、CI和MA的曲线下面积分别为0.741、0.736、0.631,灵敏度分别为65.8%、55.3%、60.6%,特异度分别为78.7%、86.2%、63.7%,最佳临界值分别为65.75°、-0.45、58.35 mm。结论:TEG参数Angle、CI和MA对骨外科创伤术后输血治疗的预测价值较大,Angle<65.75°,CI<-0.45,MA<58.35 mm可作为术后进行输血治疗的阈值。Objective:To investigate the diagnostic value of thromboelastography(TEG)in the treatment of traumatic blood transfusion in bone surgery.Methods:From December 2018 to August 2019,122 trauma patients who received routine coagulation and TEG tests in the Department of Orthopaedic Surgery of Shantou Central Hospital were analyzed retrospectively.According to whether the patients received blood transfusion during hospitalization,they were divided into transfusion group(81 cases)and non transfusion group(41 cases).The correlation between TEG and routine blood coagulation test was analyzed.The prediction efficiency of TEG and routine blood coagulation test was analyzed by receiver operating characteristic curve.Results:There was a certain correlation between the parameters of routine coagulation test and TEG parameters,among which fibrinogen concentration was negatively correlated with clot formation time(r=-0.580),and positively correlated with Angle,maximum amplitude of thrombus(MA),coagulation index(CI)(r=0.620,0.741,0.579).The AUC of Angle,CI and MA in TEG were 0.741,0.736 and 0.631,respectively.The sensitivity was 65.8%,55.3%and 60.6%.The specificity was 78.7%,86.2%and 63.7%,respectively.The best critical values were 65.75°,-0.45 and 58.35 mm,respectively.Conclusion:The TEG parameters Angle,CI and MA have a great predictive value in the treatment of blood transfusion after orthopedic trauma.Angle<65.75°,CI<0.45,MA<58.35 mm can be used as the threshold of blood transfusion.

关 键 词：血栓弹力图 骨科创伤 输血 阈值 

分 类 号：R446.1[医药卫生—诊断学]