摘要
目的探讨血栓弹力图(thrombelastography,TEG)与常规凝血试验(conventional coagulation tests,CCTs)诊断创伤性凝血病(trauma-induced coagulopathy,TIC)的临床意义及TIC的危险因素。方法选择2017年12月1日至2019年1月31日于中国医科大学附属盛京医院PICU住院的创伤患儿,按照创伤严重程度评分(injury severity score,ISS)分为非危重组(≤16分)、危重组(17~25分)和极危重组(>25分),分别于入院时/受伤后6 h、12 h、24 h和48 h采集静脉血2.5 mL,检测TEG、CCTs。总结TIC的患病率、发病时间及凝血功能恢复时间,发生TIC的危险因素。结果64例患儿,非危重组18例、危重组28例、极危重组18例,分别应用TEG及CCTs诊断TIC 9例(14.1%)、4例(6.3%)。TEG于外伤6 h即可诊断TIC,CCTs为12 h。TEG诊断4例患儿高凝状态。女性、输血、快速输液、休克、多器官功能衰竭、机械通气、低体温、低年龄、低格拉斯哥昏迷评分(glasgow coma scale,GCS)、高ISS评分均为发生TIC的危险因素。Logistics回归分析发现,女性、低体温、休克、机械通气等具有高危因素的患儿,发生TIC的风险是不具有高危因素发生TIC的4.333、17.889、10.208、4.479倍。ISS评分每升高1分,发生TIC风险提高1.147;年龄升高1岁,GCS升高1分,TIC风险分别降低0.765和0.817,是TIC的保护因素。结论TEG与CCTs诊断TIC具有一致性,但TEG更早期敏感,且能发现高凝状态。女性、休克、低体温、低年龄、高ISS评分、低GCS评分是TIC的危险因素。
Objective To explore the clinical significance of thrombelastography(TEG)and conventional coagulation tests(CCTs)in the diagnosis of trauma-induced coagulopathy(TIC)and the risk factors for TIC.Methods Traumatic patients hospitalized in PICU at Shengjing Hospital of China Medical University from December 1,2017 to January 31,2019 were divided into three groups according to injury severity score(ISS):non-severe group(≤16 points),severe group(17-25 points)and extremely severe group(>25 points).All patients received 2.5 mL of venous blood at admission/after 6 h,12 h,24 h,and 48 h injury to detect TEG and CCTs.The prevalence,time of onset,recovery time of coagulation function and risk factors for TIC were summarized.Results A total of 64 cases were collected,including 18 non-critical cases,28 critical cases and 18 extremely critical cases.TEG and CCTs were used to diagnose TIC in nine cases(14.1%)and four cases(6.3%),respectively.TIC could be diagnosed by TEG at 6 hours after trauma,and 12 hours for CCTs.TEG was used to diagnose four cases of hypercoagulability.Univariate analysis showed that female,blood transfusion,transfusion,shock,multiple organ dysfunction syndrome,mechanical ventilation,hypothermia,low age,low glasgow coma scale(GCS)and high ISS were all risk factors for TIC.Logistics regression analysis found that children with high-risk factors such as girl,hypothermia,shock and mechanical ventilation were 4.333,17.889,10.208,and 4.479 times more likely to develop TIC than those without high-risk factors.For every 1 score increase in the ISS score,the risk of TIC increased by 1.147.As the age increased by 1 year,GCS increased by 1 point,and the risk of TIC decreased by 0.765 and 0.817,respectively,which were protective factors for TIC.Conclusion TEG and CCTs are consistent in the diagnosis of TIC,but TEG is more sensitive at an earlier stage and can detect hypercoagulability.Female,shock,hypothermia,low age,high ISS,and low GCS are risk factors for TIC.
作者
李继如
关文贺
王丽杰
Li Jiru;Guan Wenhe;Wang Lijie(Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 110004,China)
出处
《中国小儿急救医学》
CAS
2020年第11期821-825,共5页
Chinese Pediatric Emergency Medicine
基金
辽宁省中央引导地方项目 (2018108001)。
关键词
创伤
创伤性凝血病
血栓弹力图
常规凝血试验
危险因素
Trauma
Trauma-induced coagulopathy
Thromboelastography
Conventional coagulation tests
Risk factors
