摘要
目的探讨血栓弹力图(TEG)在急诊多发伤患者中的应用价值。方法回顾分析2015年8月至2018年12月甘肃省人民医院急诊科收治的302例多发伤患者资料。收集患者的一般临床资料,根据损伤严重度评分(ISS)将患者分为轻伤组(ISS评分≤16分)、重伤组(ISS评分17~25分)和严重伤组(ISS评分>25分)。记录患者的生命体征、常规凝血试验、血常规、血生化及动脉血气分析结果,进行国家早期预警评分(NEWS),同时分析TEG指标。TEG各项指标与NEWS评分的相关性采用Pearson相关分析和线性回归分析;绘制受试者工作特征曲线(ROC),分析TEG指标对严重伤组患者弥散性血管内凝血(DIC)的诊断效能。结果299例患者均纳入最终分析,其中轻伤组92例,重伤组109例,严重伤组98例。随着创伤严重程度增加,NEWS评分和TEG检测指标凝血反应时间(R值)、血块生成时间(K值)均逐渐增加〔轻伤、重伤、严重伤组NEWS评分(分)分别为3.46±0.89、5.85±0.62、9.75±1.76,R值(min)分别为5.8±2.8、7.8±2.6、11.7±3.0,K值(min)分别为2.4±1.0、4.2±1.4、5.5±2.9〕,血块生成率(α角)、最大宽度值(MA值)及凝血综合指数(CI值)均逐渐减小〔轻伤、重伤、严重伤组α角(°)分别为66.9±13.5、55.7±22.9、46.8±26.3,MA值(mm)分别为51.8±9.7、48.1±17.0、38.5±15.2,CI值分别为2.0±3.6、-2.8±3.5、-6.7±2.9〕,各组间比较差异均有统计学意义(均P<0.05)。Pearson相关分析显示,多发伤患者NEWS评分与R值、K值均呈明显正相关(r值分别为0.463、0.588,均P<0.01),与α角、MA值及CI值均呈明显负相关(r值分别为-0.622、-0.689、-0.902,均P<0.01)。线性相关分析显示,R值每增加1 min,NEWS评分增加0.882分〔95%可信区间(95%CI)=0.691~1.073〕;K值每增加1 min,NEWS评分增加0.484分(95%CI=0.408~0.559);α角每增加1°,NEWS评分降低2.910分(95%CI=-3.325^-2.494);MA值每增加1 mm,NEWS评分降低2.223分(95%CI=-2.488^-1.958);CI值每增加1,NEWS评分降低1.
Objective To explore the value of thromboelastography(TEG)in patients with multiple trauma in emergency department.Methods The clinical data of 302 patients with multiple trauma hospitalized in the emergency department of Gansu Provincial People's Hospital from August 2015 to December 2018 were retrospectively analyzed.The general clinical data of the patients were collected.The patients were divided into three groups according to injury severity score(ISS):mild injury group(ISS≤16),serious injury group(ISS 17-25),and severe injury group(ISS>25).The results of vital signs,routine coagulation test,blood routine,blood biochemistry,and arterial blood gas analysis were recorded,and the National early warning score(NEWS)was calculated.TEG parameters were analyzed.Pearson correlation analysis and linear regression analysis were used to analyze the correlation between TEG indicators and NEWS score.Receiver operator characteristic(ROC)curve was plotted to analyze the diagnostic efficacy of TEG indicators for disseminated intravascular coagulation(DIC)in patients with severe injury.Results 299 patients were enrolled in the final analysis,including 92 patients in the mild injury group,109 in the serious injury group and 98 in the severe injury group.With the increase in trauma severity,the NEWS score and TEG indicators including coagulation reaction time(R value)and blood clot generation time(K value)were gradually increased[NEWS score in mild,serious,and severe injury group was 3.46±0.89,5.85±0.62,9.75±1.76,R value(minutes)was 5.8±2.8,7.8±2.6,11.7±3.0,and K value(minutes)was 2.4±1.0,4.2±1.4,5.5±2.9,respectively],and blood clot generation rate(αangle),maximum width value(MA value)and coagulation index(CI)were gradually decreased[αangle(°)in mild,serious,and severe injury group was 66.9±13.5,55.7±22.9,46.8±26.3,MA value(mm)was 51.8±9.7,48.1±17.0,38.5±15.2,and CI was 2.0±3.6,-2.8±3.5,-6.7±2.9,respectively],the differences were statistically significant among the groups(all P<0.05).Pearson correlation a
作者
曲强
魏晓东
侯景文
杨蓉佳
Qu Qiang;Wei Xiaodong;Hou Jingwen;Yang Rongjia(Department of Emergency,Gansu Provincial People's Hospital,Lanzhou 730000,Gansu,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2019年第5期623-628,共6页
Chinese Critical Care Medicine
基金
甘肃省自然科学基金(145RJZA066).
关键词
多发伤
血栓弹力图
国家早期预警评分
弥散性血管内凝血
Multiple trauma
Thromboelastography
National early warning score
Disseminated intravascular coagulation
