摘要
目的:分析血栓弹力图(TEG)对脓毒症患者病情及凝血功能紊乱的评价作用。方法:收集临床诊断为脓毒症的患者130例,按照中国弥散性血管内凝血(DIC)诊断积分系统将其分成DIC组(72例)和非DIC组(58例),2组患者均进行常规血凝指标和TEG检测,分析2组患者的常规血凝指标、TEG指标,分析TEG参数和常规凝血指标的相关性,分析TEG对脓毒症患者凝血功能紊乱的诊断价值。结果:DIC组患者的活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)和D-二聚体(D-D)均高于非DIC组,纤维蛋白原(FIB)低于非DIC组,DIC组的凝血酶形成时间(K值)和凝血反应时间(R值)高于非DIC组,而血凝块最大宽度值(MA值)和血块生成率(α角)低于非DIC组,差异均有统计学意义(P<0.05);R值、K值与APTT、PT和D-D时间呈正相关,R值与FIB值呈正相关,K值与FIB值呈负相关,MA值与PT、D-D及FIB呈正相关,而与APTT呈负相关,α角与D-D及FIB呈正相关,而与APTT和PT呈负相关,差异均有统计学意义(P<0.05);R时间、K时间、MA值及α角对DIC诊断的Youden指数分别为54.4%、80.4%、76.1%和62.9%。结论:TEG能够较准确的分析脓毒症患者的凝血状态,协助诊断严重脓毒症并发DIC,并对患者病情的严重程度的评价具有重要意义。
Objective:To evaluate the coagulation disturbances and patient’s condition with thromboelastography in patients with severe sepsis.Method:A total of 130 cases who were diagnosed with sepsis were collected from our hospital,and divided into DIC group(n=72)and non-DIC group(n=58)according to the Chinese DIC system.The routine blood coagulation index and thromboelastogram were detected between the two groups,the routine hemagglutination index and thromboelastogram index between the two groups were analyzed,the correlation between routine coagulation parameters and thromboelastogram parameters was analyzed,and the diagnostic value of thromboelastography for coagulation dysfunction in sepsis patients was analyzed.Result:The time of APTT,PT and D-D in DIC group was longer than those in non-DIC group,and the FIB value was lower than that in non-DIC group,the K value and R value in the DIC group were higher than those in the non-DIC group,while the MA value and alpha angle were lower than those in the non-DIC group(P<0.05).R value and K value were positively correlated with APTT,PT and D-D,R value was positively correlated with FIB value,K value was negatively correlated with FIB value,MA value was positively correlated with PT,D-D and FIB value,but negatively correlated with APTT,alpha angle was positively correlated with D-D time and FIB value,but negatively correlated with APTT and PT,the differences were statistically significant(P<0.05).The Youden index of R time,K time,MA value and alpha angle for DIC diagnosis was 54.4%,80.4%,76.1%and 62.9%,respectively.Conclusion:Thromboelastography can accurately analyze the coagulation state of sepsis patients,and assist in the diagnosis of severe sepsis complicated with DIC,which may be of great significance to evaluate the severity of the disease.
作者
高锡坤
陈薇
陆芳洁
卢斐
任义
GAO Xikun;CHEN Wei;LU Fangjie;LU Fei;REN Yi(Department of Critical Medicine,Changshu City Hospital of Traditional Chinese Medicine(NewDistrict Hospital),Changshu,215500,China)
出处
《临床血液学杂志（输血与检验）》
CAS
2020年第5期697-699,703,共4页
Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)
基金
常熟市科技局科技计划项目基金资助(No:CS201513)。
关键词
脓毒症
血栓弹力图
凝血功能
诊断价值
sepsis
thromboelastogram
coagulation function
diagnostic value
