活化部分凝血活酶时间、血栓弹力图、纤维蛋白单体预测体外膜肺氧合治疗患者出血和血栓  

Predictive value of activated partial thromboplastin time,thromboelastogram and fibrin monomer in patients treated with extracorporeal membrane oxygenation for hemorrhage and thrombosis

作　　者：邓爽 方靖舒 甘芳宴 DENG Shuang;FANG Jingshu;GAN Fangyan(Department of Clinical Laboratory,the People's Hospital of Guangxi Zhuang Autonomous Region,Guangxi Academy of Medical Sciences,Nanning 530021,Guangxi,China)

机构地区：[1]广西医学科学院广西壮族自治区人民医院检验科,广西南宁530021

出　　处：《检验医学》2024年第8期764-769,共6页Laboratory Medicine

摘　　要：目的探讨活化部分凝血活酶时间(APTT)、血栓弹力图(TEG)和纤维蛋白单体(FM)在体外膜肺氧合(ECMO)患者出血和血栓中的预测价值。方法选取2023年8—12月广西壮族自治区人民医院26例行ECMO治疗的患者。根据是否发生出血和血栓分别细分为出血组(16例)、无出血组(10例)和血栓组(5例)、无血栓组(21例)。收集所有患者临床资料,比较各组凝血参数的差异。采用Cox回归分析评估ECMO患者发生出血和血栓的危险因素;采用受试者工作特征(ROC)曲线评估APTT、TEG、FM预测ECMO出血和血栓的效能。结果26例患者出血和血栓发生率分别为61.5%(16/26)和19.2%(5/26),相关事件发生中位天数分别为3和6 d。出血组最大APTT、平均APTT、TEG参数反应时间(R)相关参数[普通杯(CK)、肝素酶杯(CKH)、ΔR(R_(CK)-R_(CKH))]均高于无出血组(P<0.05);血栓组FM高于无血栓组(P<0.05)。最大APTT、TEG R_(CK)、TEG R_(CKH)、TEGΔR是出血的危险因素(P<0.05),校正混杂因素后,风险比(HR)分别为1.010、1.029、1.216、1.018;FM是血栓的危险因素(P<0.05),校正混杂因素后,HR为1.008。最大APTT、TEG R_(CK)、TEG R_(CKH)、TEGΔR预测ECMO患者发生出血的ROC曲线下面积分别为0.831、0.800、0.763、0.744,联合指标的ROC曲线下面积(AUC)为0.869;FM预测ECMO患者发生血栓的ROC曲线下面积为0.868。结论最大APTT、TEG R_(CK)、TEG R_(CKH)、TEGΔR可预测ECMO患者出血,联合指标预测价值最优。FM可预测ECMO患者血栓。Objective To investigate the predictive value of activated partial thromboplastin time(APTT),thromboelastogram(TEG)and fibrin monomer(FM)in patients treated with extracorporeal membrane oxygenation(ECMO).Methods A total of 26 patients treated with ECMO were enrolled from the People's Hospital of Guangxi Zhuang Autonomous Region from August to December 2023.The patients were classified into hemorrhage group(16 cases),non-hemorrhage group(10 cases),thrombosis group(5 cases)and non-thrombosis group(21 cases)according to the occurrence of hemorrhage and thrombosis.The clinical data of all the patients were collected,and the differences of coagulation parameters were compared.The risk factors of ECMO hemorrhage and thrombosis were evaluated by Cox regression analysis.The roles of APTT,TEG and FM in predicting ECMO hemorrhage and thrombosis were evaluated by receiver operating characteristic(ROC)curve.Results The incidence rates of hemorrhage and thrombosis were 61.5%(16/26)and 19.2%(5/26),respectively.The related event occurrence median days were 3 and 6 d,respectively.The maximum APTT,average APTT,TEG reaction time(R)[citrated kaolin(CK),citrated kaolin heparinase(CKH)andΔR(R_(CK)-R_(CKH))]in hemorrhage group were higher than those in non-hemorrhage group(P<0.05),and FM in thrombosis group was higher than that in non-thrombosis group(P<0.05).Maximum APTT,TEG R_(CK),TEG R_(CKH) and TEGΔR were risk factors for hemorrhage(P<0.05),and the corrected hazard ratios(HR)were 1.010,1.029,1.216 and 1.018,respectively.FM was a risk factors of thrombosis(P<0.05)and HR was 1.008 after correction.The areas under curves of maximum APTT,TEG R_(CK),TEG R_(CKH) and TEGΔR for predicting ECMO hemorrhage were 0.831,0.800,0.763 and 0.744,respectively,and the area under curve(AUC)of combined determination was 0.869.The area under curve of FM predicted thrombosis was 0.868.Conclusions Maximum APTT,TEG R_(CK),TEG R_(CKH) and TEGΔR can be used to predict ECMO hemorrhage,and the combined determination has optimal predictive value.FM can pre

关 键 词：活化部分凝血活酶时间 血栓弹力图 纤维蛋白单体 出血 血栓 体外膜肺氧合 

分 类 号：R446.11[医药卫生—诊断学]