血栓弹力图在多发伤患者诊疗中的临床应用
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摘要
随着社会交通业的发展,全球多发伤导致的人员伤亡逐渐增多。多发伤患者常存在血管损伤、血液灌注不足和休克,并常合并创伤性凝血病。严重多发伤并发凝血机制障碍所致的"无法控制性出血"是外科学关注的焦点。血栓弹力图(TEG)的临床应用对早期发现凝血功能异常、靶向输血、节约血液资源、减少术中出血有重要意义。TEG诊断出血和血栓形成的灵敏度和特异度较常规凝血检测高,全面理解并应用TEG将有助于降低多发伤的致死率和致残率。
With the development of social transportation industry,the number of casualties caused by multiple injuries in the world has been increasing. Vascular injury,insufficient blood perfusion,shock and traumatic coagulopathy are common in patients with multiple injuries. " Uncontrollable bleeding" caused by coagulation dysfunction in severe multiple injuries is the focus of surgical attention. The clinical application of thromboelastography( TEG) is of great significance in early detection of abnormal coagulation function,targeted blood transfusion,saving blood resources and reducing intraoperative bleeding. The sensitivity and specificity of TEG in the diagnosis of hemorrhage and thrombosis are higher than those of the conventional coagulation tests. Comprehensive understanding and application of TEG will help to reduce the mortality and disability rate of multiple injuries.
With the development of social transportation industry,the number of casualties caused by multiple injuries in the world has been increasing. Vascular injury,insufficient blood perfusion,shock and traumatic coagulopathy are common in patients with multiple injuries. " Uncontrollable bleeding" caused by coagulation dysfunction in severe multiple injuries is the focus of surgical attention. The clinical application of thromboelastography( TEG) is of great significance in early detection of abnormal coagulation function,targeted blood transfusion,saving blood resources and reducing intraoperative bleeding. The sensitivity and specificity of TEG in the diagnosis of hemorrhage and thrombosis are higher than those of the conventional coagulation tests. Comprehensive understanding and application of TEG will help to reduce the mortality and disability rate of multiple injuries.
引文
[1]于鹏涛,刘暌,宋杰,等.多发伤合并中重型颅脑损伤凝血功能障碍的相关因素分析[J].创伤外科杂志,2017,19(4):270-272.
[2]Noel P,Cashen S,Patel B.Trauma-Induced Coagulopathy:From Biology to Therapy[J].Semin Hematol,2013,50(3):259-269.
[3]Evans JA,van Wessem KJ,Mc Dougall D,et al.Epidemiology of traumatic deaths:Comprehensive population-based assessment[J].World J Surg,2010,34(1):158-163.
[4]尹文,李俊杰.急性创伤性凝血病的研究进展[J].创伤外科杂志,2014,16(3):197-200.
[5]李辉,陈少军,唐朝晖,等.多发伤患者低体温、酸中毒及凝血功能障碍临床研究[J].中华急诊医学杂志,2015,24(3):310-314.
[6]岳茂兴,周培根,梁华平,等.创伤性凝血功能障碍的早期诊断和20AA复方氨基酸联用大剂量维生素B6新疗法应用[J/CD].中华卫生应急电子杂志,2015(1):4-7.
[7]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.
[8]彭光善,游靖岚.重型颅脑损伤合并多发伤的ICU监护及治疗分析[J].当代医学,2018,24(32):25-27.
[9]Park MS,Martini WZ,Dubick MA,et al.Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time[J].J Trauma,2009,67(2):266-276.
[10]徐秀凤,柯靖兰,吴越,等.血栓弹力图在肝癌患者术后临床输血中的应用价值[J].医疗装备,2018,31(17):15-17.
[11]Carroll RC,Craft RM,Langdon RJ,et al.Early evaluation of acute traumatic coagulopathy by thrombelastography[J].Transl Res,2009,154(1):34-39.
[12]Sch9chl H,Solomon C,Traintinger S,et al.Thromboelastometric(ROTEM)findings in patients suffering from isolated severe traumatic brain injury[J].J Neurotrauma,2011,28(10):2033-2041.
[13]Haas T,Spielmann N,Mauch J,et al.Reproducibility of thrombelastometry(ROTEM):Point-of-care versus hospital laboratory performance[J].Scand J Clin Lab Invest,2012,72(4):313-317.
[14]Nascimento B,Al Mahoos M,Callum J,et al.Vitamin K-dependent coagulation factor deficiency in trauma:A comparative analysis between international normalized ratio and thromboelastography[J].Transfusion,2012,52(1):7-13.
[15]Fleming K,Redfern RE,March RL,et al.TEG-Directed Transfusion in Complex Cardiac Surgery:Impact on Blood Product Usage[J].J Extra Corpor Technol,2017,49(4):283-290.
[16]王秀丽,雷芳,陈阿琴,等.高出血风险患者血栓弹力图与常规凝血试验、血小板计数的相关性[J].海南医学,2018,29(18):2521-2523.
[17]李继如,王丽杰.血栓弹力图与创伤性凝血病诊断研究进展[J].中国实用儿科杂志,2018,33(6):457-462.
[18]黄剑吟,封启明.急性创伤性凝血病发病机制的研究进展[J].海南医学,2015,26(21):3190-3194.
[19]Davenport R,Khan S.Management of major trauma haemorrhage:Treatment priorities and controversies[J].Br J Haematol,2011,155(5):537-548.
[20]阮晓岚,李胜,孟详喻,等.弥散性血管内凝血诊疗现状:ISTH/SSC最新共识解读[J].中国循证医学杂志,2015,15(9):993-999.
[21]Sharma P,Saxena R.A novel thromboelastographic score to identify overt disseminated intravascular coagulation resulting in a hypocoagulable state[J].Am J Clin Pathol,2010,134(1):97-102.
[22]Kane I,Ong A,Orozco FR,Post ZD,et al.Thromboelastography predictive of death in trauma patients[J].Orthop Surg,2015,7(1):26-30.
[23]曾庆波,宋景春,林青伟,等.创伤合并弥散性血管内凝血患者血栓弹力图诊断标准的临床研究[J].东南国防医药,2018,20(5):471-475.
[24]祁妙华,胡晓婧,曾龙宏.血栓弹力图对急性型DIC患者诊断价值[J].中国输血杂志,2018,31(4):391-393.
[25]Borgman MA,Spinella PC,Perkins JG,et al.The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital[J].J Trauma,2007,63(4):805-813.
[26]Davenport R,Curry N,Manson J,et al.Hemostatic effects of fresh frozen plasma may be maximal at red cell ratios of 1:2[J].J Trauma,2011,70(1):90-95.
[27]Jeger V,Willi S,Liu T,et al.The Rapid TEGα-Angle may be a sensitive predictor of transfusion in moderately injured blunt trauma patients[J].ScientificWorldJournal,2012,2012:821794.
[28]Weber CF,G9rlinger K,Meininger D,et al.Point-of-care testing:A prospective,randomized clinical trial of efficacy in coagulopathic cardiac surgery patients[J].Anesthesiology,2012,117(3):531-547.
[29]关金乐.产科弥散性血管内凝血的病因和临床特点及护理实施方法分析[J].当代医学,2018,24(24):171-172.
[30]徐鹏陶,吴兴,张玲,等.氨甲环酸对创伤性凝血病患者凝血功能指标与炎症因子水平的影响[J].当代医学,2018,24(17):36-38.
[31]Boudreau RM,Deshpande KK,Day GM,et al.Prehospital Tranexamic Acid Administration During Aeromedical Transport After Injury[J].J Surg Res,2019,233:132-138.
[32]周志忠,曹艳花.血栓弹力图参数在产科大出血治疗中的应用[J].中国卫生标准管理,2016,7(24):46-49.
[33]胡东涛,范红庚,韩贝贝.伴颅脑损伤的多发伤病死率的影响因素分析[J].中国临床神经外科杂志,2018,23(9):593-595.
[34]Peck KA,Calvo RY,Schechter MS,et al.The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury[J].J Trauma Acute Care Surg,2014,76(2):431-436.
[35]钟涛,许伟,胡海亮,等.应用TEG监测冠心病患者的凝血状态及评价抗血小板聚集效果的临床研究[J].中国实验血液学杂志,2018,26(5):1484-1491.
[36]张茹艳,胡越成,李曦铭,等.血栓弹力图评价经皮冠脉介入治疗患者服用抗血小板药物效果的研究[J].中国临床研究,2014,27(3):257-259,262.
[37]亓永杰,杨兴菊,段崇浩,等.血栓弹力图(TEG)在危重颅脑损伤行血肿清除术患者血液净化中的应用价值[J].智慧健康,2018,4(27):11-12.
[38]黄月明,段继新,刘劲芳,等.颅脑损伤后预防性抗凝治疗的临床意义[J].中华神经外科疾病研究杂志,2018,17(5):475-477.
[39]邓星平,曾庆波,胡炜,等.肝素酶修饰的血栓弹力图用于血液净化时肝素监测的临床研究[J].东南国防医药,2018,20(5):476-479.
[40]高晓云,贾军会,王新华,等.血栓弹力图对肝素抗凝患者血液成分输注指导初探[J].北京医学,2014,36(11):961-963.
[41]Ali JT,Daley MJ,Vadiei N,et al.Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients[J].Am J Emerg Med,2017,35(4):632-636.
[2]Noel P,Cashen S,Patel B.Trauma-Induced Coagulopathy:From Biology to Therapy[J].Semin Hematol,2013,50(3):259-269.
[3]Evans JA,van Wessem KJ,Mc Dougall D,et al.Epidemiology of traumatic deaths:Comprehensive population-based assessment[J].World J Surg,2010,34(1):158-163.
[4]尹文,李俊杰.急性创伤性凝血病的研究进展[J].创伤外科杂志,2014,16(3):197-200.
[5]李辉,陈少军,唐朝晖,等.多发伤患者低体温、酸中毒及凝血功能障碍临床研究[J].中华急诊医学杂志,2015,24(3):310-314.
[6]岳茂兴,周培根,梁华平,等.创伤性凝血功能障碍的早期诊断和20AA复方氨基酸联用大剂量维生素B6新疗法应用[J/CD].中华卫生应急电子杂志,2015(1):4-7.
[7]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.
[8]彭光善,游靖岚.重型颅脑损伤合并多发伤的ICU监护及治疗分析[J].当代医学,2018,24(32):25-27.
[9]Park MS,Martini WZ,Dubick MA,et al.Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time[J].J Trauma,2009,67(2):266-276.
[10]徐秀凤,柯靖兰,吴越,等.血栓弹力图在肝癌患者术后临床输血中的应用价值[J].医疗装备,2018,31(17):15-17.
[11]Carroll RC,Craft RM,Langdon RJ,et al.Early evaluation of acute traumatic coagulopathy by thrombelastography[J].Transl Res,2009,154(1):34-39.
[12]Sch9chl H,Solomon C,Traintinger S,et al.Thromboelastometric(ROTEM)findings in patients suffering from isolated severe traumatic brain injury[J].J Neurotrauma,2011,28(10):2033-2041.
[13]Haas T,Spielmann N,Mauch J,et al.Reproducibility of thrombelastometry(ROTEM):Point-of-care versus hospital laboratory performance[J].Scand J Clin Lab Invest,2012,72(4):313-317.
[14]Nascimento B,Al Mahoos M,Callum J,et al.Vitamin K-dependent coagulation factor deficiency in trauma:A comparative analysis between international normalized ratio and thromboelastography[J].Transfusion,2012,52(1):7-13.
[15]Fleming K,Redfern RE,March RL,et al.TEG-Directed Transfusion in Complex Cardiac Surgery:Impact on Blood Product Usage[J].J Extra Corpor Technol,2017,49(4):283-290.
[16]王秀丽,雷芳,陈阿琴,等.高出血风险患者血栓弹力图与常规凝血试验、血小板计数的相关性[J].海南医学,2018,29(18):2521-2523.
[17]李继如,王丽杰.血栓弹力图与创伤性凝血病诊断研究进展[J].中国实用儿科杂志,2018,33(6):457-462.
[18]黄剑吟,封启明.急性创伤性凝血病发病机制的研究进展[J].海南医学,2015,26(21):3190-3194.
[19]Davenport R,Khan S.Management of major trauma haemorrhage:Treatment priorities and controversies[J].Br J Haematol,2011,155(5):537-548.
[20]阮晓岚,李胜,孟详喻,等.弥散性血管内凝血诊疗现状:ISTH/SSC最新共识解读[J].中国循证医学杂志,2015,15(9):993-999.
[21]Sharma P,Saxena R.A novel thromboelastographic score to identify overt disseminated intravascular coagulation resulting in a hypocoagulable state[J].Am J Clin Pathol,2010,134(1):97-102.
[22]Kane I,Ong A,Orozco FR,Post ZD,et al.Thromboelastography predictive of death in trauma patients[J].Orthop Surg,2015,7(1):26-30.
[23]曾庆波,宋景春,林青伟,等.创伤合并弥散性血管内凝血患者血栓弹力图诊断标准的临床研究[J].东南国防医药,2018,20(5):471-475.
[24]祁妙华,胡晓婧,曾龙宏.血栓弹力图对急性型DIC患者诊断价值[J].中国输血杂志,2018,31(4):391-393.
[25]Borgman MA,Spinella PC,Perkins JG,et al.The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital[J].J Trauma,2007,63(4):805-813.
[26]Davenport R,Curry N,Manson J,et al.Hemostatic effects of fresh frozen plasma may be maximal at red cell ratios of 1:2[J].J Trauma,2011,70(1):90-95.
[27]Jeger V,Willi S,Liu T,et al.The Rapid TEGα-Angle may be a sensitive predictor of transfusion in moderately injured blunt trauma patients[J].ScientificWorldJournal,2012,2012:821794.
[28]Weber CF,G9rlinger K,Meininger D,et al.Point-of-care testing:A prospective,randomized clinical trial of efficacy in coagulopathic cardiac surgery patients[J].Anesthesiology,2012,117(3):531-547.
[29]关金乐.产科弥散性血管内凝血的病因和临床特点及护理实施方法分析[J].当代医学,2018,24(24):171-172.
[30]徐鹏陶,吴兴,张玲,等.氨甲环酸对创伤性凝血病患者凝血功能指标与炎症因子水平的影响[J].当代医学,2018,24(17):36-38.
[31]Boudreau RM,Deshpande KK,Day GM,et al.Prehospital Tranexamic Acid Administration During Aeromedical Transport After Injury[J].J Surg Res,2019,233:132-138.
[32]周志忠,曹艳花.血栓弹力图参数在产科大出血治疗中的应用[J].中国卫生标准管理,2016,7(24):46-49.
[33]胡东涛,范红庚,韩贝贝.伴颅脑损伤的多发伤病死率的影响因素分析[J].中国临床神经外科杂志,2018,23(9):593-595.
[34]Peck KA,Calvo RY,Schechter MS,et al.The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury[J].J Trauma Acute Care Surg,2014,76(2):431-436.
[35]钟涛,许伟,胡海亮,等.应用TEG监测冠心病患者的凝血状态及评价抗血小板聚集效果的临床研究[J].中国实验血液学杂志,2018,26(5):1484-1491.
[36]张茹艳,胡越成,李曦铭,等.血栓弹力图评价经皮冠脉介入治疗患者服用抗血小板药物效果的研究[J].中国临床研究,2014,27(3):257-259,262.
[37]亓永杰,杨兴菊,段崇浩,等.血栓弹力图(TEG)在危重颅脑损伤行血肿清除术患者血液净化中的应用价值[J].智慧健康,2018,4(27):11-12.
[38]黄月明,段继新,刘劲芳,等.颅脑损伤后预防性抗凝治疗的临床意义[J].中华神经外科疾病研究杂志,2018,17(5):475-477.
[39]邓星平,曾庆波,胡炜,等.肝素酶修饰的血栓弹力图用于血液净化时肝素监测的临床研究[J].东南国防医药,2018,20(5):476-479.
[40]高晓云,贾军会,王新华,等.血栓弹力图对肝素抗凝患者血液成分输注指导初探[J].北京医学,2014,36(11):961-963.
[41]Ali JT,Daley MJ,Vadiei N,et al.Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients[J].Am J Emerg Med,2017,35(4):632-636.
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