血栓弹力图对脓毒症患者凝血功能和病情严重程度的评估价值  

The value of thrombelastography in assessing the blood coagulation function of patients with sepsis and severity of conditions thereof

作　　者：李晶菁[1] 王萌 张霞[1] 姜岱山 LI Jingjing;WANG Meng;ZHANG Xia;JIANG Daishan(Department of Emergency,the Affiliated Hospital of Nantong University,Nantong 226001)

机构地区：[1]南通大学附属医院急诊科,南通226001

出　　处：《南通大学学报（医学版）》2021年第5期433-437,共5页Journal of Nantong University(Medical sciences)

基　　金：南通市科技计划项目(JCZ19057)。

摘　　要：目的:探讨血栓弹力图(thrombelastography,TEG)对脓毒症患者早期凝血功能和病情严重程度的评估价值。方法:回顾性分析2018年12月—2020年6月入住南通大学附属医院急诊监护病房的脓毒症患者69例,分为脓毒症组(25例)和脓毒性休克组(44例)。所有患者均在入院24 h内完成常规凝血功能、血常规、TEG检测、患者病情严重程度评分:序贯器官衰竭评分(sequential organ failure assessment,SOFA)和急性生理学及慢性健康状况评分系统(acute physiology and chronic health evaluation scoring systemⅡ,APACHEⅡ)评分。TEG检测指标包括凝血反应时间(R值)、血块生成时间(K值)、血块生成率(α角)、最大宽度值(MA值)、凝血综合指数(CI值)等。根据2016年改良的日本急诊医学学会评分系统(modification of Japanese association for acute medicine score,M-JAAM)将脓毒性休克组分为弥散性血管内凝血(disseminated intravascular coagulation,DIC)组25例、非DIC组19例,比较TEG各项指标在脓毒症组和脓毒性休克组,脓毒性休克DIC组和脓毒性休克非DIC组之间的差异,并分析SOFA评分与TEG各指标的相关性。结果:脓毒性休克组较脓毒症组患者R值、K值延长(F=2.285、2.250,均P<0.05),α角、MA值、CI值减小(F=2.135、2.010、2.060,均P<0.05)。脓毒性休克DIC组的R值和K值显著大于非DIC组(F=2.88,4.163,均P<0.05),脓毒性休克DIC组的α角、MA值和CI值显著小于非DIC组(F=4.988、0.577、4.692,均P<0.05)。SOFA评分与R值、K值呈明显正相关(r=0.40、0.47,均P<0.05),与α角、MA值、CI值呈明显负相关(r=-0.47、-0.38、-0.46,均P<0.05)。结论:TEG具有评估脓毒症患者病情严重程度的价值,可协助诊断脓毒症并发DIC,评估血栓、出血风险,从而指导有效准确地干预治疗,提高抢救成功率,改善预后。Objective:To explore the value of thrombelastography(TEG)in assessing the blood coagulation function of patients with sepsis in the early stage and severity of conditions thereof.Methods:This study is based on a retrospective analysis of 69 patients with sepsis admitted to the Emergency Intensive Care Unit of the Affiliated Hospital of Nantong University from December 2018 to June 2020.These patients were assigned to either a sepsis group(25 cases)or a septic group(44 cases).All of these patients,within 24 hours of admission,completed routine coagulation function tests,routine complete blood count(CBC)tests and TEG testing,and had their severity of conditions scored on the basis of the sequential organ failure assessment(SOFA)score and the acute physiology and chronic health evaluation scoring systemⅡ(APACHEⅡ)scoring system.The indicators of TEG testing include coagulation reaction time(R value),blood clot formation time(K value),blood clot formation rate(αangle),maximum width value(MA value),and coagulation comprehensive index(CI value)etc.According to the modified of Japanese association for acute medicine score(M-JAAM)in 2016,the septic shock group was divided into the disseminated intravascular coagulation(DIC)group(25 cases)and the non-DIC group(19 cases).A comparison was made between the sepsis group and the septic shock group,and between the septic shock DIC group and the septic shock non-DIC group,in terms of each indicator of TEG testing.The correlation between the SOFA score and each indicator of TEG testing was also analyzed.Results:Compared with patients in the septic group,those in the septic shock group had increased R value and K value(F=2.285,2.250,all P<0.05),and decreasedαangle,MA value,and CI value(F=2.135,2.010,2.060,all P<0.05).Compared with patients in the septic shock non-DIC group,those in the septic shock DIC group had significantly higher R value and K value(F=2.880,4.163,all P<0.05),and significantly lowerαangle,MA value and CI value(F=4.988,0.577,4.692,all P<0.05).The SOFA score

关 键 词：脓毒症 脓毒性休克 血栓弹力图 弥散性血管内凝血 

分 类 号：R446.1[医药卫生—诊断学]