摘要
目的探讨血栓弹力图在创伤性休克患者早期诊断凝血功能变化中的应用价值。方法空军军医大学第一附属医院急诊科2016年1月—2019年1月收治67例创伤性休克患者,将患者按照住院号排序后取随机数字分为弹力图检测组(34例)和常规检测组(33例)。常规检测组给予常规凝血功能检测及输血治疗,男性17例,女性16例,年龄20~86岁,平均46.78岁;轻度休克11例,中度休克16例,重度休克6例。弹力图检测组给予血栓弹力图检测及输血治疗,男性16例,女性18例,年龄23~88岁,平均47.78岁;轻度休克13例,中度休克14例,重度休克7例。观察两组凝血功能变化及其相关并发症发生率。结果常规检测组凝血功能异常诊断率为72.7%,弹力图检测组为94.1%;常规检测组并发症发生率为18.2%,弹力图检测组为3.4%,差异有统计学意义(P<0.05)。常规检测组对凝血功能异常诊断时间、住院时间均长于弹力图检测组(P<0.05);两组输血前的凝血酶时间(TT)、凝血酶原时间(PT)、部分活化凝血酶时间(APTT)、纤维蛋白原(FIB)水平组间差异无统计学意义(P>0.05);输血24h后两组TT、PT、APTT均降低,FIB水平升高,并且弹力图检测组的变化幅度大于常规检测组,差异有统计学意义(P<0.05);与输血前相比,弹力图检测组输血后24h反应时间(R)、凝固时间(K)、图中两侧曲线的最宽距离(MA)、综合凝血指数(CI)、纤维蛋白溶解度(Ly 30)、α角均升高,差异有统计学意义(P<0.05);输血后弹力图检测组血浆、血小板、红悬液、冷沉淀均低于常规检测组相应水平,差异有统计学意义(P<0.05)。结论血栓弹力图可较好地了解创伤性休克患者的凝血状态及血小板功能,从而为临床治疗提供参考依据,值得临床推广应用。
Objective To explore the application value of thromboelastography in early diagnosis of coagulation changes in traumatic shock patients.Methods A total of 67 patients with traumatic shock admitted to our hospital from Jan.2016 to Jan.2019 were randomly divided into elastogram test group(34 cases)and routine test group(33 cases).In the routine test group were 17 males and 16 females,with an average age of 46.78(20-86)years;11 cases of mild shock,16 cases of moderate shock,and 6 cases of severe shock.In the elasticity test group were 16 males and 18 females with an average age of 47.78(23-88)years;13 patients with mild shock,14 patients with moderate shock,and 7 patients with severe shock.The routine test group was given routine blood coagulation function test and transfusion therapy,and the elastogram test group was given thromboelastogram test and transfusion therapy.The changes of blood coagulation function and the incidence of complications of the two groups were observed.Results The diagnostic rate of abnormal coagulation function was 72.7%in the routine test group,94.1%in the elastogram test group,and the incidence of complications was 18.2%in the routine test group and 3.4%in the elastogram test group(P<0.05).The diagnostic time and hospitalization time of abnormal coagulation function in the routine test group were longer than those in the elastogram test group(P<0.05).There was no significant difference in TT,PT,APTT and FIB levels between the two groups before transfusion(P>0.05).TT,PT and APTT levels decreased and FIB levels increased in the two groups 24 hours after transfusion,and the change range in the elastogram test group was larger than that in the routine test group(P<0.05).R and K in the elastogram test group decreased 24 hours after transfusion,and MA and LY decreased compared with those before transfusion(P<0.05).The levels of plasma,platelet,red suspension and cryoprecipitation in the elastogram test group were lower than those in the routine test group(P<0.05).Conclusion Thromboelastography
作者
王瀚宇
尹文
WANG Han-yu;YIN Wen(The First Affiliated Hospital of PLA Air Force Military Medical University,Xi an710032,China)
出处
《创伤外科杂志》
2019年第10期730-733,共4页
Journal of Traumatic Surgery
关键词
创伤性休克
血栓弹力图
凝血功能
血小板
traumatic shock
thromboelastography
coagulation function
platelet
