严重创伤性大出血患者的预后与凝血四项和TEG评估参数的相关性研究  

Correlation of prognosis in patients with severe traumatic hemorrhage with four blood coagulation items, thrombelastography indexes

作　　者：贾昭[1] 干金文 魏伟 张建梅[1] 金刚[1] JIA Zhao;GAN Jin-wen;WEI Wei;ZHANG Jian-mei;JIN Gang(Department of Emergency Medicine,Xi'an Aerospace General Hospital,Xi'an 710100,Shaanxi,CHINA)

机构地区：[1]西安航天总医院急诊医学科,陕西西安710100

出　　处：《海南医学》2023年第4期546-549,共4页Hainan Medical Journal

基　　金：陕西省重点研发计划项目(编号:20218F-329)。

摘　　要：目的 研究严重创伤性大出血患者的预后状况及其与凝血四项、血栓弹力图(TEG)评估参数的相关性。方法 回顾性分析2019年12月至2021年11月在西安航天总医院急诊医学科诊治的58例严重创伤性大出血患者的临床资料。按照创伤严重程度评分(ISS)将患者分为危重伤组(ISS评分16~25分,24例)和重伤组(ISS评分>25分,34例)。按照诊治结果分为死亡组21例和生存组37例。比较各组患者的凝血四项[凝血酶时间(TT)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)]和TEG水平[血凝时间(R)、血块成型时间(K)、α角、血块强度(MA)],采用Spearman相关性分析凝血四项、TEG水平与预后的关系。结果 危重伤组患者的TT、APTT、PT、R、K水平分别为(25.02±2.11) s、(41.09±3.47) s、(22.55±2.16) s、(16.64±4.25) min、(14.93±4.48) min,明显高于重伤组的(21.36±1.98) s、(36.76±3.59) s、(17.09±2.14) s、(13.96±3.79) min、(11.82±3.26) min,FIB、α角、MA水平分别为(2.04±0.33) g/L、(18.23±5.38)°、(22.64±6.33) mm,明显低于重伤组的(3.49±0.30) g/L、(23.37±7.14)°、(28.61±8.27) mm,差异均有统计学意义(P<0.05);死亡组患者的TT、APTT、PT、R、K水平分别为(30.41±2.16) s、(47.23±3.87) s、(25.12±2.27) s、(18.15±5.24) min、(16.04±4.86) min,明显高于存活组的(15.89±2.31) s、(30.46±4.21) s、(14.45±2.03) s、(11.74±3.21) min、(9.51±3.02) min,FIB、α角、MA水平分别为(1.69±0.38) g/L、(15.25±4.11)°、(20.01±5.82) mm,明显低于存活组的(3.94±0.52) g/L、(26.19±8.42)°、(31.17±9.05) mm,差异均有统计学意义(P<0.05);经Spearman相关性分析结果显示,TT、APTT、PT、R、K与预后呈正相关(P<0.05),FIB、α角、MA与预后呈负相关(P<0.05)。结论 凝血四项和TEG评估参数与严重创伤性大出血患者的预后有关,联合检测凝血四项和评估TEG参数有利于临床准确判断病情,并提供合理的治疗方案。Objective To investigate the prognostic status of patients with severe traumatic hemorrhage and its correlation with four blood coagulation items and thrombelastography(TEG) indexes. Methods The clinical data of 58patients with severe traumatic hemorrhage who were diagnosed and treated in Department of Emergency Medicine,Xi’an Aerospace General Hospital from December 2019 to November 2021 were retrospectively analyzed. According to the trauma severity score(ISS), the patients were divided into the critically injured group(ISS score ranged from 16 to25 points, 24 cases) and seriously injured group(ISS score >25 points, 34 cases). According to the diagnosis and treatment results, they were divided into a death group(21 cases) and a survival group(37 cases). The four blood coagulation items [thrombin time(TT), fibrinogen(FIB), activated partial thromboplastin time(APTT), prothrombin time(PT)],TEG level [blood clotting time(R), clot formation time(K), α angle, clot strength(MA)] were compared between the critically injured group and the seriously injured group, and between the death group and the survival group. Spearman correlation was selected to analyze the relationship between the four blood coagulation items, TEG level and prognosis.Results The levels of TT, APTT, PT, R, and K in the critically injured group were(25.02±2.11) s,(41.09±3.47) s,(22.55±2.16) s,(16.64±4.25) min,(14.93±4.48) min, significantly higher than(21.36±1.98) s,(36.76±3.59) s,(17.09±2.14) s,(13.96±3.79) min,(11.82±3.26) min in the seriously injured group;FIB, α angle, MA levels were(2.04±0.33) g/L,(18.23±5.38)°,(22.64±6.33) mm, which were significantly lower than(3.49±0.30) g/L,(23.37±7.14)°,(28.61±8.27) mm in the seriously injured group;the differences were statistically significant(P<0.05). The levels of TT, APTT, PT, R, and K in the death group were(30.41±2.16) s,(47.23±3.87) s,(25.12±2.27) s,(18.15±5.24) min,(16.04±4.86) min, significantly higher than(15.89±2.31) s,(30.46±4.21) s,(14.45±2.03) s,(11.74±3.21) m

关 键 词：严重创伤性大出血 凝血酶时间 纤维蛋白原 活化部分凝血活酶时间 凝血酶原时间 血凝时间 血块成型时间 α角 血块强度 

分 类 号：R619.1[医药卫生—外科学]