血栓弹力图检测在毒蕈中毒肝损伤型患者急救中的应用价值

发布时间：2018-04-21 14:45

本文选题：毒蕈中毒 + 肝损伤　；参考：《中国输血杂志》2017年06期

【摘要】：目的通过回顾性分析16例毒蕈中毒患者的临床资料,研究毒蕈中毒肝损害型患者死亡组与存活组凝血功能是否存在差异,并探讨凝血功能与毒蕈中毒预后的相关性,从而评估血栓弹力图(TEG)在急性毒蕈中毒肝损害型患者急救中的应用价值。方法选择入院24 h前未使用过干扰凝血状况药物的毒蕈中毒肝损害型患者16例,分为死亡组(5例)和存活组(11例),入院2 h内同时抽取常规凝血试验、血常规、TEG血样,所有患者均进行枸橼酸化高岭土(CK-TEG)检测,对于R值明显延长患者加做肝素酶对比检测(CKH-TEG)。结果死亡组PT、APTT、TT明显延长,FiB、Plt明显降低,CK-TEG的R值、K值延长,CI负值明显增大,与存活组比较有统计学差异(P0.05);CKH-TEG的R值、K值、MA值、CI负值在死亡组和存活组之间比较无统计学差异(P0.05);8例肝素酶对比检测提示有肝素或类肝素物质存在。结论急性毒蕈中毒患者应用TEG可动态监测其凝血状态,R值明显延长应及时进行肝素酶对比检测,及时调整治疗策略。
[Abstract]:Objective to analyze retrospectively the clinical data of 16 cases of mushroom poisoning, to study the difference of coagulation function between death group and survival group, and to explore the correlation between coagulation function and prognosis of mushroom poisoning. To evaluate the value of thromboelastography (TEG) in emergency treatment of patients with liver injury caused by acute toadstool poisoning. Methods Sixteen patients with hepatic damage caused by muscarinic poisoning were divided into death group (n = 5) and survival group (n = 11). Routine coagulation test was taken at the same time within 2 hours after admission. All patients were tested with CK-TEG of kaolin citrate, and CKH-TEGG was detected with heparinase in patients with significantly prolonged R value. Results in the death group, PTT APTTT significantly prolonged FiBX / Plt significantly decreased the R value of CK-TEG and prolonged the K value of CK-TEG and increased the negative value of CI. There was no statistical difference between the survival group and the survival group in the R value and K value of CKH-TEG. There was no significant difference between the death group and the survival group. The contrast detection of heparinase in 8 cases showed that heparin or heparinoid substance existed. Conclusion TEG can dynamically monitor the coagulation status of patients with acute muscarinic poisoning. It is necessary to detect heparinase in time and adjust the treatment strategy.
【作者单位】：云南曲靖市第一人民医院输血科;云南曲靖市第一人民医院急诊科;云南普洱第一人民医院输血科;
【分类号】：R595.7

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