摘要
目的探究血栓弹力图(thrombelastography,TEG)对创伤性凝血病(trauma-induced coagulopathy,TIC)患者诊断和输血治疗的价值。方法回顾性分析2018年2月至12月在上海交通大学附属第六人民医院急诊重症监护室接受TEG和常规凝血功能检查(conventional coagulation tests,CCTs)的创伤患者。TIC定义为凝血酶原时间(prothrombin time,PT)>18 s,国际标准化比率(international normalized ratio,INR)>1.5,活化部分凝血活酶时间(activated partial thromboplastin time,APTT)>60 s或血小板计数(platelet count,PLT)<100×109/L。通过受试者工作特性曲线、曲线下面积(area under the curve,AUC)、灵敏度、特异度、阳性预测值(positive predictive value,PPV)和阴性预测值(negative predictive value,NPV)探究TEG的诊断价值,并通过多元回归分析评估TEG的输血指导价值。结果共纳入242例患者,TIC组62例,非TIC组180例,两组间TEG结果差异有统计学意义。血栓最大振幅(maximum amplitude,MA)和凝血指数(coagulation index,CI)诊断TIC的AUC最大,分别为0.779和0.786,且两者灵敏度大于80%,NPV大于90%;凝血反应时间(reaction time,R)的灵敏度、PPV和NPV最小。在控制混杂因素后,所有TEG参数均与TIC患者入院24 h内输血量和大量输血有关,R的比值比和回归系数最大。结论MA和CI对TIC的诊断价值最大,R的诊断价值较小但输血指导意义较大。MA<52.9 mm或CI<-1.0可作为诊断TIC的阈值。使用TEG检测创伤患者的凝血功能状态有助于诊断TIC并指导患者的早期输血治疗。
Objective To assess the diagnosis of thrombelastography(TEG)for trauma-induced coagulopathy(TIC)and explore whether TEG could guide transfusion for TIC patients.Methods We retrospectively analyzed all trauma patients who underwent the TEG and conventional coagulation tests(CCTs)admission in the emergency intensive care unit from February to December 2018.The definition of TIC is prothrombin time(PT)18 s,international normalized ratio(INR)1.5,activated partial thromboplastin time(APTT)60 s or platelet count(PLT)100×109/L.The diagnostic value of TEG for TIC was evaluated by receiver operating characteristic curve,area under the curve(AUC),sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV),and the transfusion guidance of TEG for TIC patients was assessed by multivariate regression analyses.Results A total of 242 patients were included,including 62 patients in the TIC group and 180 patients in the non-TIC group.The differences in TEG between the two groups were statistically significant.The AUCs of TIC assessed by maximum amplitude(MA)and coagulation index(CI)were the largest,0.779 and 0.786 respectively,and the sensitivity were greater than 80%and NPV were greater than 90%.The sensitivity,PPV and NPV of reaction time(R)were minimal.After confounders were controlled,all TEG values were correlated with blood volumes within the first 24 h and massive transfusion,of which R had the highest odds ratio and regression coefficient.Conclusions MA and CI have the highest diagnostic value,while R has little diagnostic value but a relatively large blood therapeutic significance of TIC.MA<52.9 mm or CI<-1.0 can be used as a threshold for identifying TIC.The diagnosis of TIC and the guidance transfusion for TIC patients by TEG is beneficial.
作者
徐文心
朱晓光
李梅芳
黄剑吟
吴蔚
周敏杰
封启明
Xu Wenxin;Zhu Xiaoguang;Li Meifang;Huang Jianyin;Wu Wei;Zhou Minjie;Feng Qiming(Department of Emergency Medicine,Sixth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200233,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2019年第4期504-509,共6页
Chinese Journal of Emergency Medicine
基金
国家自然科学基金(81502316).
关键词
血栓弹力图
创伤性凝血病
诊断
输血治疗
Thrombelastography
Trauma-induced coagulopathy
Diagnosis
Transfusion treatment
