血栓弹力图在严重创伤后早期入院患者临床用血的应用  

Application of thrombelastogram in blood transfusion for patients in early stage of severe trauma

作　　者：李晓明[1] 段秀群[1] 张伟[1] LI Xiaoming;DUAN Xiuqun;ZHANG Wei(Ezhou Central Hospital,Ezhou 436000,China.)

机构地区：[1]鄂州市中心医院输血科,湖北鄂州436000

出　　处：《中国输血杂志》2023年第12期1136-1139,共4页Chinese Journal of Blood Transfusion

摘　　要：目的探讨血栓弹力图(TEG)对严重创伤后早期入院患者凝血功能的监测价值及临床用血的指导价值。方法选取本院于2019年1月—2020年12月收治的严重创伤后早期入院的患者共96例,根据随机数表法分成2组,每组各48例。采用常规凝血4项指导对照组输血,观察组则采用TEG指导输血。对比2组患者的创伤性凝血病的阳性检出率、检测用时,入院24 h内的血制品输注量,输血后不同时间点的凝血指标水平,住院时间、入住ICU时间及死亡率。结果对照组创伤性凝血病的阳性检出率72.9%,观察组为93.8%(P<0.05);观察组在入院24 h内的新鲜冰冻血浆输注量(35.13±4.75)U、红细胞输注量(5.19±1.41)U明显低于对照组的(45.17±6.54)U、(7.08±1.32)U(P<0.05);冷沉淀输注量(36.78±2.49)U、血小板输注率79.2%高于对照组的(24.84±3.92)U与22.9%(P<0.05)。观察组在输血后8 h的APTT(58.16±10.39)s、PT(15.44±3.22)s、TT(21.39±4.51)s、R(13.03±3.29)min、K(8.07±3.65)min明显低于对照组的APTT(70.83±14.99)s、PT(17.32±2.89)s、TT(25.18±4.73)s、R(14.95±4.57)min、K(10.54±5.14)min(P<0.05);FIB(2.02±0.46)g/L、MA(35.56±11.88)mm、α(40.07±13.34)°、Plt(135.87±59.13)×109/L高于对照组的FIB(1.09±0.27)g/L、MA(29.57±9.25)mm、α(27.23±10.87)°、Plt(108.17±52.08)×109/L(P<0.05)。结论TEG对严重创伤后早期入院患者凝血功能有比较好的监测价值,能够指导严重创伤后早期入院患者的临床输血。Objective To explore the value of thrombelastogram(TEG)on monitoring the coagulation function and guiding blood transfusion in admitted patients in early stage of severe trauma.Methods A total of 96 patients in early stage of severe trauma were selected from Ezhou Central Hospital,and were divided into two groups using a random number table method,with 48 patients in each group.The control group was guided by four routine coagulation tests for blood transfusion,while the observation group was guided by TEG.The detection rate of trauma-induced coagulopathy,detection duration,blood infusion volume within 24 hours of admission,coagulation index levels at different time points after blood transfusion,length of hospital stay,ICU stay,and mortality rate between the two groups were compared.Results The detection rate of trauma-induced coagulopathy was 72.9%in the control group and 93.8%in the observation group(P<0.05).The transfusion volume of fresh frozen plasma(U)and red blood cell(U)in the observation group within 24 hours of admission were significantly lower than those in the control group,which were(35.13±4.75)vs(45.17±6.54),(5.19±1.41)vs(7.08±1.32)(P<0.05);the tranfusion volume of cryoprecipitate(U)and the rate of platelet transfusion in the observation group were significantly higher than those in the control group,which were(36.78±2.49)vs(24.84±3.92),79.2%vs 22.9%(P<0.05).The APTT(s),PT(s),TT(s),R(min),and K(min)in the observation group 8 hours after blood transfusion were significantly lower than those in the control group,which were(58.16±10.39)vs(70.83±14.99),(15.44±3.22)vs(17.32±2.89),(21.39±4.51)vs(25.18±4.73),(13.03±3.29)vs(14.95±4.57),and(8.07±3.65)vs(10.54±5.14)(P<0.05),while FIB(g/L),MA(mm),α(°),and Plt(×109/L)were higher than those in the control group,which were(2.02±0.46)vs(1.09±0.27),(35.56±11.88)vs(29.57±9.25),(40.07±13.34)vs(27.23±10.87),and(135.87±59.13)vs(108.17±52.08)(P<0.05).Conclusion TEG can help monitoring the coagulation function in patients in early stage of se

关 键 词：血栓弹力图 临床用血 严重创伤 

分 类 号：R457.11[医药卫生—治疗学] R641[医药卫生—临床医学]