血栓弹力图在颅脑损伤患者凝血障碍检查中的应用

doi:10.3877/cma.j.issn.2095-9141.2018.02.002

目的

探讨血栓弹力图（TEG）作为TBI患者凝血功能障碍预测指标的可行性。

方法

选取山西医科大学附属大医院神经外科自2017年2月至11月收治的颅脑损伤（TBI）60例患者，根据入院GCS评分分为重型组（GCS≤8分）38例，轻型组（GCS>8分）22例，均于伤后24 h内同时行TEG及常规凝血检查，另选取同期16名健康体检者作为对照组，观察3组的各项凝血参数的差异；同时比较2种检查方法的相关性。

结果

3组对比常规凝血检查和TEG各项参数，活化部分凝血活酶时间（APTT）、血小板计数（PLT）的差异无统计学意义（Ρ>0.05），其余参数差异均有统计学意义（Ρ<0.05）；TEG参数与常规凝血检查指标存在一定的相关性，反应时间与凝血酶原时间、APTT呈正相关，凝血块形成时间与纤维蛋白浓度呈显著负相关，凝血块形成速率与纤维蛋白浓度呈显著正相关，最大振幅与PLT呈显著正相关。

结论

重型与轻型TBI患者凝血功能障碍存在差异性，前者更为严重；联合应用TEG和常规凝血检查可全面评估TBI患者早期凝血功能状态。

关键词: 颅脑损伤, 血栓弹力图, 凝血功能障碍

Objective

Investigated the feasibility of thrombelastogram (TEG) in detection coagulation disorder in patients with traumatic brain injury (TBI).

Methods

According to GCS scores, 78 cases gathered in Department of Neurosurgery, the Shanxi Academy of Medical Sciences, were divide into two groups: heavy group (GCS≤8 scores), 38 cases: light group (GCS>8 scores) 22 cases, and 16 healthy persons were selected as the control group. Comparing the difference of coagulation system functional changes performed within 24 h after injury in the three groups and analyzing the correlation between TEG and traditional coagulation.

Results

In each group, the differences of all indicators in TEG and traditional coagulation were statistically significant (P<0.05), but the differences of APTT and PLT were not statistically significant (P>0.05). And the correlation between the results reported by two methods existed in a certain degree. R value was positively correlated with PT and APTT, fibrinogen was positively correlated with α angle, but negatively correlated with K value, MA value was positively correlated with platelet count.

Conclusion

Coagulation disorder of patients with severe TBI appears more severe than that of those with mild one. Combined use of TEG and traditional coagulation can evaluate comprehensively the early coagulation status of patients with TBI.

Key words: Brain injury, Thrombelastography, Coagulation disorders

表1 3组患者的常规凝血功能指标对比（±s）

组别	PT(s)	APTT(s)	Fib(g/L)	PLT(×10⁹/L)
对照组	11.69±1.08	28.05±4.91	3.30±0.52	218.67±74.77
轻型组	12.64±0.92^a	22.70±2.50	2.61±1.23^a	194.87±72.03^a
重型组	13.63±1.95^ab	29.05±5.35^ab	2.14±1.20^ab	190.46±71.56^a
F值	18.363	0.860	11.891	1.411
Ρ值	<0.001	0.375	0.001	0.239

表1 3组患者的常规凝血功能指标对比（±s）

组别	PT(s)	APTT(s)	Fib(g/L)	PLT(×10⁹/L)
对照组	11.69±1.08	28.05±4.91	3.30±0.52	218.67±74.77
轻型组	12.64±0.92^a	22.70±2.50	2.61±1.23^a	194.87±72.03^a
重型组	13.63±1.95^ab	29.05±5.35^ab	2.14±1.20^ab	190.46±71.56^a
F值	18.363	0.860	11.891	1.411
Ρ值	<0.001	0.375	0.001	0.239

表2 3组患者的的血栓弹力图指标对比（±s）

凝血指标	R值(min)	K值(min)	α角（°）	MA值(mm)
对照组	5.35±1.06	1.65±0.37	67.22±4.04	63.71±6.73
轻型组	4.92±0.69^a	1.85±0.37	65.20±3.97^a	59.11±3.94^a
重型组	4.01±1.75^ab	3.44±3.15^ab	57.02±16.44^ab	56.01±13.55^ab
F值	12.016	8.591	9.831	6.290
Ρ值	0.001	0.004	0.002	0.014

表2 3组患者的的血栓弹力图指标对比（±s）

凝血指标	R值(min)	K值(min)	α角（°）	MA值(mm)
对照组	5.35±1.06	1.65±0.37	67.22±4.04	63.71±6.73
轻型组	4.92±0.69^a	1.85±0.37	65.20±3.97^a	59.11±3.94^a
重型组	4.01±1.75^ab	3.44±3.15^ab	57.02±16.44^ab	56.01±13.55^ab
F值	12.016	8.591	9.831	6.290
Ρ值	0.001	0.004	0.002	0.014

图1 血栓弹力图与常规凝血检测的相关性分析

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Application of thromboelastography in detection of coagulation disorder in patients with traumatic brain injury

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Application of thromboelastography in detection of coagulation disorder in patients with traumatic brain injury