相同国际血栓与止血协会评分下血栓弹力图参数在创伤大失血及脓毒症中的差异及意义  

Differences and significance of thromboelastographic indexes between trauma/major bleeding and sepsis under the same ISTH score

作　　者：李晓彤 李鑫[1] 孙旖旎[1] 李露 马晓春[1] LI Xiao-tong;LI Xin;SUN Yi-ni;LI Lu;MA Xiao-chun(The First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院重症医学科,辽宁沈阳110001

出　　处：《中国实用内科杂志》2021年第6期515-520,共6页Chinese Journal of Practical Internal Medicine

基　　金：辽宁省省直医院改革重点临床科室诊疗能力建设项目(LNCC2014)。

摘　　要：目的探讨在相同国际血栓与止血协会(ISTH)评分下,利用血栓弹力图(TEG)评价脓毒症及创伤大失血患者凝血状态的差异及意义。方法纳入中国医科大学附属第一医院重症医学科收治的脓毒症(247例)及创伤大失血患者(61例)共308例,在显性弥散性血管内凝血(DIC)(ISTH≥5分)和隐性DIC(ISTH<5分)两种情况下进行比较。比较脓毒症与创伤大失血患者的一般情况,入ICU 1、2、3 d(后称d1、d2、d3)检测患者常规凝血指标和TEG参数;同时记录患者的输血输液情况,包括输血制品类型及输注量。结果(1)隐性DIC患者中,与脓毒症患者相比,创伤大失血患者d1时K值显著增高,α角和MA值显著降低(P<0.05)。而在d2、d3时创伤大失血患者TEG结果恢复至正常,脓毒症患者TEG结果随时间变化无明显变化。(2)显性DIC患者中,创伤大失血和脓毒症患者在d1时均表现为R值、K值升高,α角及MA值降低,而在d2、d3时创伤大失血患者TEG结果恢复至正常,脓毒症患者TEG结果随时间变化无明显改善。(3)创伤大失血组输血人数较脓毒症组更多,输血量也较脓毒症组更大;经输血治疗,创伤大失血患者d2时R值、K值、Angle值、MA值较d1时明显改善(P<0.05);而脓毒症患者输血后TEG参数无明显改变(P>0.05)。结论利用TEG监测发现,创伤大失血患者的低凝状态经输血治疗后可明显改善,TEG能反映创伤大失血患者凝血功能并指导治疗;而脓毒症患者在不同ISTH评分下TEG表现存在差异,TEG对脓毒症患者凝血功能监测的临床价值尚不能确定。Objective Explore the differences and significance of thromboelastography(TEG)comparing septic patients with trauma/major bleeding patients under the same ISTH score.Methods A total of 308 patients diagnosed with trauma/major bleeding(61 patients)and sepsis(247 patients)were enrolled from the ICU of the First Affiliated Hospital of China Medical University.According to the ISTH score,the two groups of patients were compared in the two cases of dominant DIC(ISTH≥5 points)and recessive DIC(ISTH<5 points).Compare the general conditions of patients with trauma/major bleeding.On the first day(d1),second day(d2),and third day(d3)after entering ICU,the traditional coagulation and TEG parameters were recorded.Additionally,record the patients’blood transfusions including the type and amount.Results(1)In patients with recessive DIC,compared to patients with sepsis,the K value was significantly higher,and theαangle and MA values were significantly lower in patients with trauma/major bleeding on d1(P<0.05).On d2 and d3,the TEG results of patients with trauma/major bleeding returned to normal,and the TEG results of patients with sepsisdid not change significantly over time.(2)In patients with dominant DIC,patients with trauma/major bleeding and sepsis showed increased R value and K value,and decreasedαangle and MA value on d1,while TEG results of patients with trauma/major bleeding on d2 and d3 returning to normal,the TEG results of patients with sepsis showed no significant improvement over time.(3)The number of blood transfusions in the trauma/major bleeding group was more than that of the sepsis group,and the amount of blood transfusion was larger.After blood transfusion,the R value,K value,Angle value,and MA value of patients with trauma/major bleedingon d2 significantly improved compared with that on d1(P<0.05);while there was no significant changes in TEG parameters in patients with sepsis after blood transfusion(P>0.05).Conclusion The use of TEG monitoring found that the hypocoagulable state of patients with trau

关 键 词：血栓弹力图 创伤 脓毒症 国际血栓与止血协会评分 弥散性血管内凝血 

分 类 号：R631[医药卫生—外科学]