摘要
目的探讨低温对严重创伤患者凝血功能的影响及血栓弹力图（thromboelastogra—phy，TEG）监测的价值。方法选择2010年1月-2011年6月急诊ICU收治的22例严重创伤患者，留取静脉血分别在37℃、35℃、33℃下测定TEG，分析凝血反应时间（R）、凝血形成时间（K）、凝血形成速率（Angle）、凝血最终强度（MA）和凝血综合指数（CI）等随温度变化的规律。根据37℃下cI值分为凝血功能正常和异常组，分析两组患者温度对TEG指标的影响和组间的差异。结果（1）22例严重创伤患者随着温度的降低，TEG的R、K值呈延长趋势（P〈0．01），Angle、MA、CI呈降低趋势（P〈0．01）。（2）从37℃降到35℃，除反映纤维蛋白原功能的K和Angle明显受抑制外（P〈0．05），其余指标的变化差异并无统计学意义。而从35qC降到33℃，所有指标的变化差异均有统计学意义。（3）TEG各指标受低温抑制的变化差异有统计学意义（P〈0．01），除R和K、Angle和MA之间无差异外，其他指标两两比较差异均有统计学意义（P〈0．01）。（4）37℃下凝血功能正常、异常两组中，R、K值均随温度的降低而延长，而Angle、MA、CI值则减小，异常组的值明显要比正常组差。结论低温对严重创伤患者凝血功能有较大影响。TEG可以在任何温度下测定，能更准确反映患者实际体温下的凝血功能，并有助于指导临床选择合适的亚低温治疗温度。
Objective To investigate effect of hypothermia on coagulation function in major trauma patients and assess value of thromboelastography （TEG） monitoring. Methods Twenty-two patients with major trauma admitted to the emergency intensive care unit between January 2010 and June 2011 were enrolled in the study. The venous blood of the patients was sampled for TEG determination at different temperatures （37, 35 and 33 ℃ ） to analyze variation of the indices including coagulation reaction time （R）, clot formation time （K）, rate of clot formation （Angle）, maximum amplitude （MA） and coagulation index （CI）. The patients were divided into normal coagulation group and abnormal coagulation group based on the CI value at 37 ℃ to analyze effects of temperature on TEG indices in both groups and their differences between groups. Results （ 1 ） Among 22 patients, TEG indices including R and K trended upward （ P 〈 0.01 ）, but Angle, MA and CI trended downward （P 〈 0.01 ） with decline of the temperatures. （2） K and Angle values, indicators of fibrinogen function, were obviously inhibited （P 〈 0. 05 ） with the temperature decreasing from 37 ℃ to 35 ℃, but other TEG indices had no significant changes. Whereas, all TEG indices were significantly inhibited when the temperature was decreased from 35 ℃ to 33 ℃. （3） There were significant differences in variation of each TEG index inhibited by hypothermia （P 〈 0.01 ）. All TEG indices showed significant differerees in the pairwisecomparison, except for the differences between R and K as well as between Angle and MA （P 〈0.01 ）. （4） R and K were increased, but Angle, MA and CI were decreased in both groups, with decline of the temperatures. Moreover, all TEG indices in the abnormal group were worse than those in the normal group. Conclusions Hypothermia has significant effect on coagulation function of patients with major trauma. TEG, which may be measured at any temperature, is more accurate in reflection of patients＇ actual coagulation function and is helpful for choice of an appropriate temperature in the mild hypothermia therapy.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2013年第1期10-14,共5页
Chinese Journal of Trauma
基金
浙江省重大科技专项和优先主题资助项目（2009C03010-3）
浙江省教育厅科研资助项目（Y201119819）
关键词
创伤和损伤
血液凝固障碍
低温
血栓弹力图
Wounds and injuries
Blood coagulation disorders
Hypothermia
Thromboelas-tography
作者简介
蔡海英，电话：13575581589，Email：K1514@163.com
通信作者：张茂，电话：13757119125，Email：zmhz@hotmail．com
