摘要
目的探讨血栓弹力图(TEG)对热射病(HS)合并弥散性血管内凝血(DIC)的诊断及预后判断价值。方法选取解放军94医院重症医学科2016年6月-2017年9月收治的HS患者32例。收集患者入科2h内静脉血,检测血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT),纤维蛋白原(FIB)、凝血酶原时间(TT)、纤维蛋白降解产物(FDP)、D-二聚体(D-D)、抗凝血酶Ⅲ(ATⅢ)和TEG指标。比较ISTH-DIC(国际血栓与止血学会诊断标准)与TEG-DIC诊断标准。患者根据预后分为生存组(n=24)与死亡组(n=8),比较两组患者入科时常规凝血指标与TEG各指标的变化,分析TEG评分与病死率的相关性。结果与生存组凝血反应时间[R值,6.5(5.70～11.6)min]及血块形成速率[K值,3.8(2.30～6.3)min]相比,死亡组R值[30.9(10.28～88.58)min]与K值[22.4(4.9～41.63)min]明显延长。与生存组血块形成动力学指标α角(45.77±19.06)°、血块最大强度MA值(46.82±13.45mm)、凝血综合指数[CI值,–3.1(–10.30～–1.50)]相比,死亡组α角(12.68±13.65)°、MA值(19.60±21.67mm)及CI值[–22.3(–45.18～–17.3)]均明显降低,差异有统计学意义(P<0.05)。符合TEG-DIC诊断标准的DIC患者发病率较ISTH-DIC高,TEG评分与病死率呈正相关(r2=0.8372,P=0.0292)。结论 TEG评分≥2分可诊断HS合并DIC以及判断预后不良。
Objective To investigate the clinical value of thrombelastography（TEG） in the diagnosis and prognosis judgement of heatstroke with disseminated intravascular coagulation（DIC）. Methods Thirty-two patients with heatstroke were selected from the 94 th Hospital of Chinese PLA during Jun. 2016 and Sep. 2017. The general information and laboratory test of the patients within two hours after admission were collected or performed, including prothrombin time, activated partial thromboplastin time（APTT）, fibrinogen（FIB）, thrombin time（TT）, plasma fibrin degradation products（FDP）, D-Dimer（D-D）, antithrombin Ⅲ（ATⅢ） and the TEG parameters. The TEG-DIC and ISTH-DIC criteria were compared. The patients were divided into survival group（n=24） and death group（n=8） according to prognosis. The results of coagulation test and thromboelastograph were compared. The relationship between TEG score and mortality were investigated. Results Compared with the reaction time [R value, 6.5（5.7-11.6）min] and kinetics of clot development [K value, 3.8（2.3-6.3）min] of survival group, the R value [30.9（10.28-88.58）min] and K value [22.4（4.90-41.63）min] of death group were significantly higher（P〈0.05）. Compared with the α angle（45.77±19.06）°, maximum amplitude（MA） value（46.82±13.45 mm） and CI value [–3.1（–10.3-–1.5）] of survival group, the α angle（12.86±13.65）°, MA value（19.60±21.76 mm） and CI value [–22.3（–45.18-–13.70）] of death group were significantly lower（P〈0.05）. Compared with ISTH-DIC criteria, the TEG-DIC criteria found more incidence with a similar severity of the disease（mortality, 58.3% vs. 57.1 %）. According to the linear regression analysis, there was a positive correlation between TEG score and mortality（r^2=0.8372, P=0.0292）. Conclusion TEG score ≥2 can diagnose heatstroke with DIC and indicate the poor prognosis.
作者
曾庆波
宋景春
林青伟
宋晓敏
邓星平
吴阳
钟林翠
ZENG Qing-bo;SONG Jing-chun;LIN Ojng-wei;SONG Xiao-min;DENG Xing-ping;WU Yang;ZHONG Lin-cui(Department of lntensive Care Unit,94th Hospital of Chinese PLA,Nanchang 330002,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2018年第9期752-755,共4页
Medical Journal of Chinese People's Liberation Army
基金
国家自然科学基金(81573783)
关键词
热射病
血栓弹力图
弥散性血管内凝血
heatstroke
thrombelastography
disseminated intravascular coagulation
