血栓弹力图最大振幅评价重症创伤患者预后及其影响因素的分析  

Analysis of the maximum amplitude of thromboelastogram to evaluate the prognosis of patients with severe trauma and its influencing factors

作　　者：田艳 赖冬 姬长甫 孙颖 Tian Yan;Lai Dong;Ji Changfu;Sun Ying(Department of Blood Transfusion,Second Affiliated Hospital of Xiamen Medical College,Xiamen 361021,China)

机构地区：[1]厦门医学院附属第二医院输血科,厦门361021

出　　处：《血栓与止血学》2024年第2期58-62,共5页Chinese Journal of Thrombosis and Hemostasis

基　　金：厦门医学院附属第二医院院级重点专科计划项目(XYEY2023002)。

摘　　要：目的研究血栓弹力图(TEG)最大振幅(MA)评价重症创伤患者预后的作用及其影响因素。方法回顾性分析2020年07月到2023年07月我院急诊科和ICU收治的损伤严重度评分(ISS)评分≥16的重度创伤患者112例。根据TEG的MA值将患者分为MA≥50 mm组(71例)和MA<50 mm组(41例),并对两组患者的凝血酶⁃抗凝血酶复合物(TAT)、组织纤溶酶原激活物⁃纤溶酶原激活物抑制剂⁃1复合物(t⁃PAIC)、纤溶酶⁃α2纤溶酶抑制物复合物(PIC)、纤维蛋白原(FIB)、血小板(PLT)计数和ISS评分指标进行统计分析。结果与MA≥50 mm组相比,MA<50 mm组患者TAT、PIC、t⁃PAIC和ISS评分均明显升高(P<0.05或P<0.01);FIB和PLT计数明显降低(P<0.01)。相关性分析结果显示,MA与tPAIC、TAT、PLT计数和ISS评分等指标相关(P<0.05),且与PIC和FIB相关度较高(0.4<r<0.7,P<0.05)。MA≥50 mm组重症创伤患者的28 d死亡率(26.73%)明显低于PLT计数≥100×10^(9)/L组(44.44%)(P<0.05);MA<50 mm组重症创伤患者的28 d死亡率(75.61%)明显高于PLT计数<100×10^(9)/L组(45.00%)(P<0.01)。ROC曲线显示MA预测重症创伤患者存活率的曲线下面积(AUC)为0.776,明显高于PLT计数预测重症创伤患者存活率的AUC(0.563)(P<0.01)。结论TEG的MA能有效评价重症创伤患者的预后,且与创伤严重程度有关。Objective To study the effect of TEG maximum amplitude(MA)in evaluating the prognosis of patients with severe trauma and analyze the influencing factors.Methods From July 2020 to July 2023,112 patients with severe trauma with injury severity score(ISS)≥16 in the emergency department and ICU of our hospital were recruited.The patients were divided into MA≥50 mm group(71 cases)and MA<50 mm group(41 cases).The thrombine⁃antithrombin complex(TAT),tissue plasminogen activator⁃plasminogen activator inhibitor⁃1 complex(tPAIC),plasminogenα2 plasminogen inhibitor complex(PIC),fibrinogen(FIB),platelet(PLT)count,ISS score,gender and age were statistically analyzed in two groups of patients.ROC curve analysis for survival was performed by MA and PLT..Results Compared with MA≥50 mm group,TAT,PIC,t⁃PAIC and ISS scores in MA<50mm group were significantly increased(P<0.05 or P<0.01).The FIB and PLT counts were significantly decreased(P<0.01).Correlation analysis results showed that MA was correlated with tPAIC,TAT,PLT count and ISS score(P<0.05),and was highly correlated with PIC and FIB(0.4<r<0.7,P<0.05).The 28⁃day mortality of severe trauma patients in MA≥50 mm group(26.73%)was significantly lower than that in PLT≥100×10^(9)/L group(44.44%)(P<0.05).The 28⁃day mortality of severe trauma patients in MA<50 mm group(75.61%)was significantly higher than that in PLT<100×10^(9)/L group(45.00%)(P<0.01).The ROC curve showed that the area under the curve(AUC)of MA in predicting the survival rate of patients with severe trauma was 0.776,which was significantly higher than the AUC of PLT count in predicting the survival rate of patients with severe trauma(0.563).Conclusion Compared with PLT count,MA of TEG is more accurate in predicting the prognosis of patients with severe trauma,and is related to the relevant indicators reflecting the degree of trauma,hyperfibrinolysis and thrombin production capacity.

关 键 词：ISS评分 重度创伤 血小板功能 纤溶亢进 凝血酶 

分 类 号：R641[医药卫生—外科学]