血栓弹力图纤维蛋白原功能试验在创伤替代治疗中的应用研究  

Clinical study on the timing of fibrinogen replacement therapy guided by functional fibrinogen thrombelastography

作　　者：钟林翠 林青伟 齐勇 吴骏 何龙平 余甜 宋景春[1] Zhong Lincui;Lin Qingwei;Qi Yong;Wu Jun;He Longping;Yu Tian;Song Jingchun(Intensive Care Unit,908th Hospital of Chinese PLA Logistical Support Force,Nanchang 330002,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇八医院重症医学科,南昌市血栓与止血学重点实验室,南昌330002

出　　处：《血栓与止血学》2022年第6期1209-1213,共5页Chinese Journal of Thrombosis and Hemostasis

基　　金：江西省卫健委科技计划(20204819)。

摘　　要：目的 探讨采用血栓弹力图(TEG)纤维蛋白原功能试验指导创伤时启动纤维蛋白原替代治疗的指征。方法 回顾性分析2018年4月至2020年7月在联勤保障部队第908医院重症医学科治疗的76例创伤患者的临床资料,依据入科时纤维蛋白原水平是否小于2 g/L将患者分为对照组(n=25)和低纤维蛋白原组(n=51),对患者的常规凝血检查、TEG普通杯和功能性纤维蛋白原杯试验的相关参数进行统计学分析。结果 针对TEG普通杯参数比较,两组患者的R值差异无统计学意义(P>0.05),低纤维蛋白原组较对照组的患者的α、MA和CI显著降低,K显著延长(P<0.05)。针对TEG功能性纤维蛋白原试验比较,两组患者的凝血反应时间(R)值差异无统计学意义(P>0.05),但低纤维蛋白原组患者的最大振幅(MA)[7.1(3.8,10.5)mm]值和纤维蛋白原活性功能(FLEV)[156.8(127.3,186.1)mg/dL]比对照组的MA [14.7(10.5,25.1)mm]值和FLEV[268.2(191.6,458.0)mg/dL]均显著降低(P<0.05)。ROC曲线分析示当MA取9.0 mm时曲线下面积(AUC)为0.84(95%CI:0.737~0.945),当FLEV取163.4 mg/dL时AUC为0.86(95%CI:0.763~0.957)(P<0.05)。相关性分析显示纤维蛋白原与K、α、MA、FLEV的相关系数分别为-0.47、0.47、0.67、0.70(P<0.001)。结论 MA<9.0 mm或FLEV<163.4 mg/dL是创伤患者进行纤维蛋白原替代治疗的参考指标。Objective To explore the optimal indications of applying functional fibrinogen thrombelastography(FF⁃TEG)to guide fibrinogen replacement therapy during trauma.Methods A total of 76 trauma patients admitted to the Intensive Critical Unit Of the 908th Hospital of Chinese PLA from April 2018 to July 2020 were included.According to whether the fibrinogen level was less than 2 g/L,the patients were divided into control group(n=25)and hypofibrinogen group(n=51).The relevant parameters of patients'conventional coagulation tests,kaolin⁃TEG parameters and FF⁃TEG parameters were statistically analyzed.Results For kaolin⁃TEG parameters,there was no significant difference in R value between the two groups(P>0.05).Compared with the control group,theα,MA and CI value were significantly reduced,and the K value was significantly prolonged in the hypofibrinogen group(P<0.05).For FF⁃TEG parameters,there was no significant difference in coagulation reaction time(R)between the two groups of patients(P>0.05).Compared with the maximum amplitude(MA)[14.7(10.5,25.1)mm]value and fibrinogen activity function(FLEV)[268.2(191.6,458.0)mg/dL]of the control group,the MA[7.1(3.8,10.5)mm]and FLEV[156.8(127.3,186.1)mg/dL]of the hypofibrinogen group were significantly reduced(P<0.05).ROC curve analysis shows that the area under the curve(AUC)is 0.84(95%CI:0.737 to 0.945)when the MA takes 9.0 mm,and the AUC is 0.86(95%CI:0.763 to 0.957)when the FLEV takes 163.4 mg/dL(P<0.05).Correlation analysis showed that the correlation coefficients of FIB and K,α,MA,FLEV were-0.47,0.47,0.67,0.70,respectively(P<0.001).Conclusion MA<9.0 mm or FLEV<163.4 mg/dL are reference indications for fibrinogen replacement therapy in trauma patients.

关 键 词：创伤 纤维蛋白原 纤维蛋白原功能试验 血栓弹力图 

分 类 号：R446.11[医药卫生—诊断学]