Clinical study of thromboelastography in the diagnosis of traumatic coagulopathy after craniocerebral injury
-
摘要:
目的 观察血栓弹力图(TEG)检测用于诊断颅脑损伤后创伤性凝血病的临床效果及预后评估价值。 方法 以2018年12月—2021年2月台州市中医院收治的200例颅脑损伤患者为研究对象，所有患者均分别进行常规凝血项目检测和TEG检测，统计常规凝血项目检测和TEG检测在颅脑损伤后不同时间对于创伤性凝血病的检出情况，比较不同时间和不同预后水平颅脑损伤患者TEG指标差异，分析各TEG检测指标与创伤性凝血病患者死亡的相关危险因素。 结果 TEG检测于颅脑损伤后4 h和12 h对创伤性凝血病检出率(34.50%和63.00%)均显著高于常规凝血项目检测水平(18.50%和40.50%)，χ2=13.143、20.275，均P < 0.001，且严重颅脑损伤患者创伤性凝血病发生率(84.81%)显著高于非严重颅脑损伤患者(48.76%，χ2=26.647，P < 0.001)；颅脑损伤者损伤后12 h反应时间(R)值和血凝块形成时间(K)值均较损伤后4 h水平显著增加，而α角度(Angle)值和最大幅度(MA)值均较损伤后4 h水平显著减小(均P < 0.001)；死亡患者R值与生存患者水平差异无统计学意义(t=1.583，P=0.116)，而K值显著高于生存患者水平，且Angle值和MA值均显著低于生存患者水平(均P < 0.001)；MA值为导致创伤性凝血病患者死亡的相关危险因素。 结论 TEG检测可动态监测颅脑损伤患者早期凝血功能变化，有效识别创伤性凝血病的发生情况，并可用于颅脑损伤后创伤性凝血病患者预后水平的早期评估。 Abstract:Objective To observe the clinical effect and prognostic value of thromboelastography (TEG) in the diagnosis of traumatic coagulopathy after craniocerebral injury. Methods Total 200 patients with acute craniocerebral injury in our hospital were selected as the research objects from December 2018 to February 2021. All patients were detected by routine coagulation test and TEG test. The detection of traumatic coagulopathy by routine coagulation test and TEG test at different time after craniocerebral injury was statistically analyzed. The TEG indexes of patients with craniocerebral injury at different time and different prognosis levels were compared, and the related risk factors of death in patients with traumatic coagulopathy were analyzed. Results ]The detection rate of TEG in 4 hours and 12 hours of traumatic coagulopathy (34.50% and 63.00%) after craniocerebral injury was significantly higher than that of conventional coagulopathy (18.50% and 40.50%, χ2=13.143, 20.275, P < 0.001), and the incidence of traumatic coagulopathy in patients with severe craniocerebral injury (84.81%) was significantly higher than that in patients with non-severe craniocerebral injury (48.76%, χ2=26.647, P < 0.001). The R and K values at 12 h after injury were significantly higher than those at 4 h after injury, while the angle and Ma values were significantly lower than those at 4 h after injury (P < 0.001). There was no significant difference between the R value of the dead patients and the survival patients (t=1.583, P=0.116), but the K value was significantly higher than the survival patients, and the angle value and MA value were significantly lower than the survival patients (P < 0.001). The MA value was the related risk factor of death in patients with traumatic coagulopathy. Conclusion TEG detection can dynamically monitor the early changes of coagulation function in patients with craniocerebral injury, effectively identify the occurrence of traumatic coagulopathy, and can be used for early evaluation of prognosis of patients with traumatic coagulopathy after craniocerebral injury. -
表 1 颅脑损伤患者不同时间TEG指标比较(x±s)
颅脑损伤时间 例数 R(min) K(min) Angle(°) MA(mm) 颅脑损伤后4 h 200 8.53±1.27 2.65±0.48 59.63±5.27 53.49±5.03 颅脑损伤后12 h 200 11.62±1.69 3.49±0.67 50.28±4.86 42.27±4.29 t值 7.352 5.471 7.926 10.348 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 
下载: 导出CSV
表 2 不同预后水平创伤性凝血病患者TEG指标比较(x±s)
预后情况 例数 R(min) K(min) Angle(°) MA(mm) 死亡 45 14.53±1.94 4.29±0.67 44.56±4.39 35.49±3.82 生存 81 13.94±1.75 3.85±0.59 48.17±4.75 41.08±4.35 t值 1.744 3.819 4.254 7.312 P值 0.084 ＜0.001 ＜0.001 ＜0.001
下载: 导出CSV
表 3 创伤性凝血病患者预后与TEG指标的logistic回归分析
TEG指标 β SE Wald χ2 P值 OR(95% CI) R(min) 0.095 0.116 1.165 0.726 0.907(0.841~0.963) K(min) 0.216 0.137 1.974 0.208 0.941(0.875~0.993) Angle(°) 0.359 0.145 2.068 0.194 0.953(0.862~1.039) MA(mm) 0.461 0.228 4.753 0.021 1.198(1.065~1.374)
下载: 导出CSV
-
[1] 黄静, 闫新明. 血栓弹力图及常规凝血功能与多发伤患者创伤严重程度的研究[J]. 实用骨科杂志, 2019, 25(9): 804-807, 829. https://www.cnki.com.cn/Article/CJFDTOTAL-SGKZ201909010.htm [2] 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. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC201512004.htm [3] 张国丽, 冯贵龙. 创伤后凝血功能障碍的相关因素研究进展[J]. 中西医结合心脑血管病杂志, 2019, 17(15): 2305-2307. doi: 10.12102/j.issn.1672-1349.2019.15.016 [4] 舒振云, 陈明志, 廖金平, 等. 颅脑损伤患者创伤后凝血病发生的影响因素分析[J]. 创伤外科杂志, 2016, 18(11): 645-647, 662. https://www.cnki.com.cn/Article/CJFDTOTAL-CXWK201611003.htm [5] 梅程清, 叶正龙, 邹晖, 等. 多发伤患者创伤性凝血病影响因素分析[J]. 中国医刊, 2017, 52(12): 85-88. doi: 10.3969/j.issn.1008-1070.2017.12.025 [6] 王君, 白颖, 周宁. 创伤性凝血病发生的危险因素及其对多发创伤患者预后的影响[J]. 临床急诊杂志, 2018, 19(2): 113-116. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC201802011.htm [7] 曾良. 严重创伤合并创伤性凝血病的临床治疗观察[J]. 中国社区医师, 2019, 35(14): 17. doi: 10.3969/j.issn.1007-614x.2019.14.010 [8] 沈哲源, 田书委, 孔宇, 等. 创伤性凝血病发病机制及诊治研究进展[J]. 中华创伤杂志, 2018, 34(4): 377-384. doi: 10.3760/cma.j.issn.1001-8050.2018.04.015 [9] 李力卓, 何松柏, 赵格晶娃. 中老年人群急性单发性创伤性颅脑损伤相关性凝血病的临床分析[J]. 首都医科大学学报, 2018, 39(4): 537-540. doi: 10.3969/j.issn.1006-7795.2018.04.011 [10] 高竹风, 徐晓峰, 毛永强, 等. 基层医院诊断与治疗中老年颅脑创伤性凝血病体会[J]. 中国现代神经疾病杂志, 2019, 19(12): 981-986. doi: 10.3969/j.issn.1672-6731.2019.12.013 [11] 王小卫, 张婉琼, 王荣辉, 等. 中重型创伤性颅脑损伤患者凝血功能变化及对预后的影响[J]. 实用医院临床杂志, 2018, 15(6): 64-67. doi: 10.3969/j.issn.1672-6170.2018.06.020 [12] 曹敏, 张军. 血栓弹力图的临床应用新进展[J]. 国际检验医学杂志, 2019, 40(2): 246-249. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ201902032.htm [13] 林就孟, 梁金凤, 闫玉静, 等. 血栓弹力图的临床应用及研究进展[J]. 中国医药科学, 2020, 10(22): 30-33, 37. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX202022007.htm [14] 龚艳君, 邱林, 屈晨雪, 等. 血栓弹力图评价冠状动脉介入治疗术后抗血小板药物疗效及与预后的关系[J]. 中华全科医学, 2016, 14(8): 1289-1292. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201608015.htm [15] 梁天寿, 郑志民, 周刚. 早期血栓弹力图在严重颅脑创伤患者输血指导中的作用[J]. 深圳中西医结合杂志, 2020, 30(24): 125-127. https://www.cnki.com.cn/Article/CJFDTOTAL-SZZX202024059.htm [16] 徐文心, 朱晓光, 李梅芳, 等. 血栓弹力图对创伤性凝血病患者诊断和输血治疗的研究[J]. 中华急诊医学杂志, 2019, 28(4): 504-509. doi: 10.3760/cma.j.issn.1671-0282.2019.04.021 [17] 李鑫, 马晓春. 血液黏弹性检测对创伤性凝血病目标导向输血治疗策略的研究进展[J]. 中华重症医学电子杂志(网络版), 2019, 5(2): 190-193. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYD201902019.htm [18] 曾庆波, 宋景春, 杨洋, 等. 创伤患者血小板功能障碍对预后判断的临床价值[J]. 医学研究生学报, 2019, 32(8): 845-849. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYB201908012.htm -
点击查看大图
表(3)
计量
- 文章访问数: 263
- HTML全文浏览量: 102
- PDF下载量: 6
- 被引次数: 0
