血栓弹力图在脓毒症患者凝血功能障碍中的应用
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摘要
目的:对血栓弹力图在脓毒症患者凝血功能障碍中的应用进行分析。方法:选取2017-10-01—2018-06-30期间收治的67例脓毒症患者,将其分为DIC组和非DIC组,两组患者分别进行传统凝血指标(APTT、PT、TT、INR、FIB、DD、PLT等)与血栓弹力图检测,比较传统凝血指标与血栓弹力图在脓毒症凝血功能障碍患者中的改变,并进行回归分析。结果:与非DIC组比较,DIC组患者常规凝血检查中APTT、PT、TT均显著延长,INR、DD升高,PLT、FIB下降,差异有统计学意义(P<0.05);血栓弹力图指标中α角、MA、CI明显降低,R、K指标升高,差异有统计学意义;传统凝血指标与血栓弹力图检测的相关性分析表明,R与PT、INR、TT为中度正相关,K与FIB为中度负相关,α与FIB中度正相关,MA与PLT、FIB为中度正相关,CI与PT、INR为中度负相关,与FIB、PLT为中度正相关。在两种不同检测方法的结果与CDSS评分的相关性分析中,CDSS评分与APTT、PT、DD常规凝血检验结果呈现为中度正相关,与PLT呈高度负相关;与血栓弹力图中R、K为正相关,与α角、MA、CI呈负相关,且CDSS评分与血栓弹力图中的各指标相关性较好,其中与MA值具有高度相关性。结论:在脓毒症凝血功能障碍患者中应用血栓弹力图具有较好效果,可以更全面准确地提示患者凝血功能异常,具有较大早期诊断价值,值得推广。
Objective:To analyze the application of thromboelastography in sepsis patients with coagulopathy.Method:67 patients with septic coagulopathy who were admitted between October 1,2017 and June 30,2018 were enrolled.They were tested for traditional coagulation parameters and thromboelastogram(TEG).Changes in the disseminated intravascular coagulation(DIC)score were compared and regression analysis was performed.Result:Compared with the non dominant DIC patients,the indicators in the dominant DIC patients' routine coagulation examination APTT、PT、TT were significantly extended,INR and DD were increased,PLT and FIB were significantly depressed.The indicators(α-angle、MA and CI)in the TEG examination of the dominant DIC patients' were significantly lower,and other indicators were increased.Correlation analysis between traditional coagulation index and thromboelastography showed that R was positively moderately correlated with PT,INR and TT.K was negatively moderately correlated with FIB,αwas negatively moderately correlated with FIB,and MA was positively moderately correlated with PLT and FIB.CI was positively moderately correlated with FIB and PLT,and was negatively moderately correlated with PT and INR.The CDSS score was positively moderately correlated with the results of routine coagulation test of APTT,PT,DD,and highly negatively related to PLT.R,K were positively correlated with CDSS score and thromboelastogram,and negatively correlated with a-angle,MA and CI.Conclusion:The application of thromboelastography in patients with septic coagulopathy has a good effect,which can prompt patients with abnormal coagulation function,which has great early diagnostic value and is worthy of promotion.
Objective:To analyze the application of thromboelastography in sepsis patients with coagulopathy.Method:67 patients with septic coagulopathy who were admitted between October 1,2017 and June 30,2018 were enrolled.They were tested for traditional coagulation parameters and thromboelastogram(TEG).Changes in the disseminated intravascular coagulation(DIC)score were compared and regression analysis was performed.Result:Compared with the non dominant DIC patients,the indicators in the dominant DIC patients' routine coagulation examination APTT、PT、TT were significantly extended,INR and DD were increased,PLT and FIB were significantly depressed.The indicators(α-angle、MA and CI)in the TEG examination of the dominant DIC patients' were significantly lower,and other indicators were increased.Correlation analysis between traditional coagulation index and thromboelastography showed that R was positively moderately correlated with PT,INR and TT.K was negatively moderately correlated with FIB,αwas negatively moderately correlated with FIB,and MA was positively moderately correlated with PLT and FIB.CI was positively moderately correlated with FIB and PLT,and was negatively moderately correlated with PT and INR.The CDSS score was positively moderately correlated with the results of routine coagulation test of APTT,PT,DD,and highly negatively related to PLT.R,K were positively correlated with CDSS score and thromboelastogram,and negatively correlated with a-angle,MA and CI.Conclusion:The application of thromboelastography in patients with septic coagulopathy has a good effect,which can prompt patients with abnormal coagulation function,which has great early diagnostic value and is worthy of promotion.
引文
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[12]熊建,鲁传豪,陈实,等.血栓弹力图在急诊科的应用[J].临床急诊杂志,2018,19(1):70-72.
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[15]杨伟强,谢美芳,徐欣晖,等.脓毒症患者血栓弹力图、凝血参数等指标的分析及临床意义[J].临床急诊杂志,2015,16(6):407-410.
[16]董林剑,李元海.血栓弹力图的临床应用及发展[J].安徽医药,2015,19(5):817-820.
[17]尉小聪,仝海波.血栓弹力图在颅脑损伤患者凝血障碍检查中的应用[J].中华神经创伤外科电子杂志,2018,4(2):68-72.
[18]黄鹤,马莉.血栓弹力图的应用进展[J].现代临床医学,2015,41(3):163-165,171.
[19]朱建宏,邹子俊,植耀炜,等.血栓弹力图在脓毒症患者病情评估中的作用研究[J].岭南现代临床外科,2018,18(1):93-96.
[20]刘红升,王曼,苏琴,等.急性重症创伤患者凝血功能异常的临床意义[J].创伤外科杂志,2014,16(5):399-402.
[21]王宝燕,郭斌,万春晶,等.血栓弹力图在危重患者救治中的应用评价[J].临床血液学杂志(输血与检验版),2014,27(2):274-276.
[22]刘方睿,余泽波.血栓弹力图对肝病患者凝血功能的评估及输血指导研究进展[J].医学信息,2018,31(8):42-45.
[2]穆恩,刘志永,马晓春.血栓弹力图在重症加强治疗病房中的应用[J].中华危重病急救医学,2016,28(5):474-477.
[3]项龙,钱娟,张建,等.血栓弹力图法评估凝血紊乱与儿童脓毒症严重程度及预后的相关性[J].中国小儿急救医学,2016,23(5):315-320.
[4]何婧瑜,周晓超,邢绣荣,等.血栓弹力图对脓毒症患者预后预测价值的研究[J].中国临床医生杂志,2017,45(7):45-49.
[5]王霞,王春艳.血栓弹力图的应用进展[J].现代医药卫生,2017,33(6):853-855.
[6]何婧瑜,周晓超,王庆玲,等.血栓弹力图最大血块强度值对脓毒症患者血小板减少预测价值的研究[J].中国医学装备,2017,14(6):97-102.
[7]Guo Z,Wang Z,An J.GW27-e0866 Thrombelastogram Monitoring as a guidance of the Antiplatelet Therapy in ACS Patients During Perioperative Period of PCI[J].J Am College Cardiol,2016,68(16):C107-C107.
[8]邹艳平,张瑚敏.血栓弹力图参数与脓毒血症抗感染无效的相关性分析[J].四川医学,2016,37(9):1041-1043.
[9]薛峥,朱晓霞,王秀杰.凝血功能障碍患者血栓弹力图的临床应用[J].医学综述,2017,23(15):3097-3101.
[10]王学锋.血栓弹力图的临床应用评价[J].临床检验杂志,2017,35(12):887-891.
[11]范彦琦,覃炳军,何瑞玲,等.血栓弹力图评价多发伤患者凝血功能障碍[J].现代医院,2017,17(3):444-446,449.
[12]熊建,鲁传豪,陈实,等.血栓弹力图在急诊科的应用[J].临床急诊杂志,2018,19(1):70-72.
[13]靳冰,蒋学兵.血栓弹力图临床应用研究进展[J].人民军医,2016,59(1):82-84.
[14]支少敏,谢建刚,王玉同,等.血栓弹力图在重型多发伤患者创伤性凝血病早期诊断中的意义[J].临床急诊杂志,2015,16(12):917-919.
[15]杨伟强,谢美芳,徐欣晖,等.脓毒症患者血栓弹力图、凝血参数等指标的分析及临床意义[J].临床急诊杂志,2015,16(6):407-410.
[16]董林剑,李元海.血栓弹力图的临床应用及发展[J].安徽医药,2015,19(5):817-820.
[17]尉小聪,仝海波.血栓弹力图在颅脑损伤患者凝血障碍检查中的应用[J].中华神经创伤外科电子杂志,2018,4(2):68-72.
[18]黄鹤,马莉.血栓弹力图的应用进展[J].现代临床医学,2015,41(3):163-165,171.
[19]朱建宏,邹子俊,植耀炜,等.血栓弹力图在脓毒症患者病情评估中的作用研究[J].岭南现代临床外科,2018,18(1):93-96.
[20]刘红升,王曼,苏琴,等.急性重症创伤患者凝血功能异常的临床意义[J].创伤外科杂志,2014,16(5):399-402.
[21]王宝燕,郭斌,万春晶,等.血栓弹力图在危重患者救治中的应用评价[J].临床血液学杂志(输血与检验版),2014,27(2):274-276.
[22]刘方睿,余泽波.血栓弹力图对肝病患者凝血功能的评估及输血指导研究进展[J].医学信息,2018,31(8):42-45.
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