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中华卫生应急电子杂志

中华卫生应急电子杂志 ›› 2018, Vol. 04 ›› Issue (03) : 157 -161. doi: 10.3877/cma.j.issn.2095-9133.2018.03.007

所属专题： 文献；

论著

传统凝血试验与血栓弹力图检测诊断腹部创伤患者凝血功能障碍的比较研究
周一夫1, 赵振国1, 刘双海1,†()   
  1. 1. 214400　江苏江阴，东南大学医学院附属江阴市人民医院普通外科
  • 收稿日期:2018-05-02 出版日期:2018-06-18
  • 通信作者: 刘双海

Comparison between conventional coagulation testing and thromboelastography for evaluation of trauma-induced coagulopathy in abdominal trauma patients

Yifu Zhou1, Zhenguo Zhao1, Shuanghai Liu1,†()   

  1. 1. Department of general surgery, Jiangyin people’s Hospital Affiliated to Medical College of Southeast University, Jiangyin 214400, China
  • Received:2018-05-02 Published:2018-06-18
  • Corresponding author: Shuanghai Liu
  • About author:
    Corresponding author: Liu Shuanghai, Email:
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引用本文：

周一夫, 赵振国, 刘双海. 传统凝血试验与血栓弹力图检测诊断腹部创伤患者凝血功能障碍的比较研究[J]. 中华卫生应急电子杂志, 2018, 04(03): 157-161.

Yifu Zhou, Zhenguo Zhao, Shuanghai Liu. Comparison between conventional coagulation testing and thromboelastography for evaluation of trauma-induced coagulopathy in abdominal trauma patients[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2018, 04(03): 157-161.

目的

比较传统凝血试验(conventional coagulation test, CCT)和血栓弹力图分析仪(thromboelastography，TEG)在诊断腹部创伤患者凝血功能障碍的价值。

方法

选择2017年1月至2018年1月东南大学医学院附属江阴市人民医院普通外科收治的38例以腹部创伤为主患者同时进行CCT与TEG监测，比较两种检测方法诊断凝血功能障碍的敏感性与特异性；并对发现创伤后早期(≤6 h)患者亚组进行比较分析。

结果

腹部创伤患者凝血功能障碍CCT阳性率(8例，21.1%)明显低于TEG(阳性21，55.2%，P<0.05)；创伤后早期凝血功能障碍CCT阳性率(3/13，23.1%)亦明显低于TEG(9/13，69.2%，P<0.05)。

结论

TEG诊断创伤后凝血功能障碍的敏感性与特异性明显优于CCT方法，特别是对于创伤后早期凝血功能障碍的诊断TEG更具有优势。

关键词: 创伤后凝血功能障碍, 传统凝血试验, 血栓弹力图检测, 创伤严重程度评分
Objective

To compare the clinical usage of TEG (thromboelastography, TEG) and (conventional coagulation tests, CCT) in diagnosing trauma-induced coagulopathy.

Methods

The clinical data of 38 patients with abdominal trauma, from January 2017 to January 2018, were prospectively reviewed. Both of thromboelastography(TEG) and CCT were immediately performed at the patients’ arrival. Data were analyzed to compare the differences of sensitivity of the two test methods in finding TIC of all trauma patients and only in the patients who got hurt within 6 hours, and the correlation of two methods with the ISS. All data were analyzed by using chi-square test, t-test, Fisher exact test and Spearman rank analysis.

Results

The CCT results of 8 (21.1%) patients were positive, and the TEG results of 21 (55.2%) patients were positive. Furthermore, there was 1 patient showing negative in the TEG among the 8 patients whose CCT results were positive, while 14 patients showing negative in the CCT among the 21 patients whose TEG results were positive. The significant difference between the two groups (P =0.037) can be noticed. There were 13 patients admitted to hospital within 6 hours, among whom 3 (23.1%) patients were positive in CCT and 9 (69.2%) patients were positive in TEG. All the 3 patients with positive CCT results were also positive in TEG, and the 6 patients with positive TEG results were negative in CCT. There was significant difference between the two different groups (P =0.028) as well. R value in TEG test was related to ISS, and PT, APTT, K value were not related to ISS.

Conclusion

Based on our preliminary results, TEG was better than CCT in diagnosing TIC (trauma-induced coagulopathy)and ATC (Acute Traumatic Coagulopathy), with higher positive rates and better sensitivity.

Key words: Trauma-Induced Coagulopathy(TIC), Conventional Coagulation Testing(CCT), thrombelastogram(TEG), injury severity score(ISS)
图1 入选患者筛选流程
表1 患者一般资料
项目 年龄 性别 致伤原因 ISS 出院方式
男 女 钝性伤 穿通伤 0～20 21～40 41～60 > 60 正常 死亡 伤后入院时间(h)
值(区间或百分比) 35(18-70) 29(76.3%) 9(23.4%) 36(94.7%) 2(5.3%) 7(18.4%) 22(57.9%) 5(13.2%) 4(10.5%) 36(94.7%) 2(6.3%) 8.6(1.5-24)
表2 CCT与TEG检测结果
项目 ? CCT 例(%)
＋ －
TEG ＋ 7 14 21(55.2)
－ 1 16 17(44.8)
例(%) ? 8(21.1) 30(78.9) 38(100)
表3 早期入院患者CCT与TEG检测结果
项目 ? CCT 例(%)
＋ －
TEG ]＋ 3 6 9(69.2)
－ 0 4 4(30.8)
例(%) ? 3(23.1) 10(76.9) 13(100)
图2 TEG和CCT检测结果与ISS的相关性
1
Wei A, Liao L, Xiang L, et al.Congenital dysfibrinogenaemia assessed by whole blood thromboelastography[J]. Int J Lab Hematol, 2018, 9(30): 130-139.
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Giordano S, Spiezia L, Campello E, et al.The current understanding of trauma-induced coagulopathy (TIC): a focused review on pathophysiology[J]. Intern Emerg Med, 2017, 12(7): 981-991.
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Stettler GR, Moore EE, Moore HB, et al.Thrombelastography indicates limitations of animal models of trauma-induced coagulopathy[J]. J Surg Res, 2017, 217(2): 207-212.
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Mohamed M, Majeske K, Sachwani GR, et al.The impact of early thromboelastography directed therapy in trauma resuscitation[J]. Scand J Trauma Resusc Emerg Med, 2017, 25(1): 99.
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Martini WZ, Cortez DS, Dubick MA, et al.Thrombelastography is better than PT, aPTT, and activated clotting time in detecting clinically relevant clotting abnormalities after hypothermia, hemorrhagic shock and resuscitation in pigs[J]. J Trauma, 2008, 65(3): 535-543.
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Schöchl 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): 2033-41.
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Fröhlich M, Mutschler M, Caspers M, et al.Trauma-induced coagulopathy upon emergency room arrival: still a significant problem despite increased awareness and management？[J]. Eur J Trauma Emerg Surg, 2017, (26): 577-583.
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Moore EE, Moore HB, Chapman MP, et al.Goal-directed hemostatic resuscitation for trauma induced coagulopathy: maintaining homeostasis[J]. J Trauma Acute Care Surg, 2018(34): 445-450.
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