血栓弹力图在创伤后大出血患者输血治疗中的作用

发布时间：2018-02-04 07:54

本文关键词： 血栓弹力图创伤出血凝血指标　出处：《中国输血杂志》2017年09期 　论文类型：期刊论文

【摘要】：目的探讨血栓弹力图(TEG)对创伤后大出血患者血液输注的指导意义。方法回顾分析自2014年3月到2016年3月本院需要大量输血的创伤后大出血患者122例,将血栓弹力图指导下用血的患者57例为A组,只用凝血四项指导下用血的患者65例为B组。比较2组患者输血前后凝血4项和血栓弹力图各指标水平变化,创伤性凝血病的阳性率,输血后的预后情况及输血量的差异。结果在输血后A组和B组患者凝血指标APTT(s)、PT(s)、FIB(g/L)和TT(s)的平均水平(35.82±8.58,34.82±8.58)、(12.22±2.57,13.22±2.16)、(2.82±1.33、2.56±1.25)和(15.49±4.01、14.62±3.85)都比输血前有明显改善(P0.01);A组病人输血后好转率66.7%高于B组的47.7%(P0.05),而手术后渗血时间(30.68±22.76)h和病死率15.8%低于B组的(39.73±25.59)h和32.3%(P0.05或P0.01);A组患者TEG检测创伤性凝血病的阳性率73.7%高于凝血4项检测的阳性率28.1%(χ2=17.36,P0.01)。在用血方面,A组红细胞(U)和血浆(mL)的使用量(6.93±5.16,700±604.53)明显低于B组(12.38±9.01,1032.86±846.56)(P0.05或P0.01);而血小板(治疗量)和冷沉淀(U)(0.89±0.80,16.31±12.80)高于B组(0.37±0.77,8.69±11.85)(P0.01),A组用血总量低于B组。结论 TEG不仅能针对性指导创伤后大出血病人的血液输注,还能更有效地改善病人预后并节约血液资源。
[Abstract]:Objective to study the thromboelastography (TEG). Methods from March 2014 to March 2016, 122 patients with massive blood transfusion were analyzed retrospectively. 57 patients with thromboelastography were divided into group A and 65 patients under only four instructions of thromboplastin as group B. the changes of 4 items of thromboplastin and 4 items of thromboelastogram before and after blood transfusion were compared between the two groups. The positive rate of traumatic thromboplasmosis, the prognosis after blood transfusion and the quantity of blood transfusion were different. The average levels of FIBG / L and TTX) were 35.82 卤8.58, 34.82 卤8.58, 12.22 卤2.57 and 13.22 卤2.16). 2.82 卤1.33 (2.56 卤1.25) and 15.49 卤4.01 (14.62 卤3.85) were significantly improved compared with those before blood transfusion. The improvement rate of group A was 66.7% higher than that of group B (47.7% P0.05). However, the time of blood leakage after operation was 30.68 卤22.76 hours and the mortality was 15.8%, which was lower than that in group B (39.73 卤25.59) and 32.3C (P0.05 or P0.01). The positive rate of TEG in group A was 73.7% higher than that in 4 items of coagulation (蠂 2 17.36 P 0.01). In group A, the usage of RBC) and plasma mL-1 were significantly lower than those in group B (6.93 卤5.16 卤700 卤604.53) and 12.38 卤9.01, respectively. 1032.86 卤846.56 P 0.05 or P 0.01; The platelet (therapeutic dose) and cold precipitate (0.89 卤0.80) were significantly higher than those in group B (0.37 卤0.77). The total amount of blood used in group A was lower than that in group B.Conclusion TEG can not only guide blood transfusion in patients with massive hemorrhage after trauma. It can also improve the prognosis of patients and save blood resources more effectively.
【作者单位】：厦门医学院附属医院厦门市第二医院输血科;
【分类号】：R457.1
【正文快照】： 创伤后由凝血障碍导致的大出血是引起创伤后24 h内死亡的重要因素,约有16.3%的患者发生凝血功能障碍[1],因此监测创伤后的凝血功能并及时有效改善创伤后早期低凝状态显得尤为重要。TEG[2]是1种在体外模拟人体凝血全过程的检测方法,它能在短时间内提供凝血因子水平、纤维蛋白和

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