血栓彈力圖在急診顱腦損傷患者凝血功能障礙及病情程度判斷中的應(yīng)用價(jià)值

鄒海軍 陳晨 李天星

[摘要]目的 探討血栓彈力圖（TEG）在急診顱腦損傷患者凝血功能障礙及病情程度中的判斷價(jià)值。方法 將佛山市三水區(qū)人民醫(yī)院急診科2016年1月～2017年6月收治的90例急診顱腦損傷患者作為研究對(duì)象，90例顱腦損傷患者經(jīng)TEG的凝血綜合指數(shù)（CCI）判斷后，將患者分為高凝組（n=50）、低凝組（n=11）、正常組（n=29）。90例顱腦損傷患者經(jīng)格拉斯哥昏迷指數(shù)（GCS）評(píng)分評(píng)定顱腦損傷病情程度，將患者分為重度組（n=32），中度組（n=42），輕度組（n=16）。分別檢測(cè)血漿凝血酶原時(shí)間（PT）、凝血酶時(shí)間（TT）、活化部分凝血活酶時(shí)間（APTT）、纖維蛋白降解產(chǎn)物（FDP）及D-二聚體（D-D）水平，測(cè)量TEG的反應(yīng)時(shí)間（R）、凝固時(shí)間（K）、血栓最大幅度（Ma）、凝固角（α）、凝血塊強(qiáng)度（G）及凝血綜合指數(shù)（CCI），對(duì)比TEG與凝血檢測(cè)結(jié)果。結(jié)果 高凝組的R、K時(shí)間顯著短于低凝組及正常組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；高凝組的Ma、α、G顯著高于低凝組及正常組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；高凝組的FDP顯著高于正常組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；高凝組的D-D顯著高于低凝組及正常組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；重度組的R、K時(shí)間顯著短于輕度組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；重度組的Ma、α、G、D-D顯著高于中度及輕度組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 血栓彈力圖與常規(guī)凝血指標(biāo)比較，可更好地區(qū)分急診顱腦損傷的病情程度，可更快及準(zhǔn)確地了解凝血功能狀況。

[關(guān)鍵詞]急診顱腦損傷；血栓彈力圖；凝血功能障礙；病情程度

[中圖分類號(hào)] R457.1 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-4721（2019）5（c）-0008-05

Application value of thromboelastography in coagulation dysfunction and judgment of severity of illness of patients with emergency craniocerebral injury

ZOU Hai-jun CHEN Chen LI Tian-xing

Department of Emergency， People′s Hospital in Sanshui District of Foshan City， Guangdong Province， Foshan 528100， China

[Abstract] Objective To explore the value of thromboelastography （TEG） on judgment of coagulation dysfunction and the severity of illness in emergency traumatic brain injury. Methods A total of 90 patients with emergency traumatic brain injury admitted from January 2016 to June 2017 from People′s Hospital in Sanshui District of Foshan City were selected as subjects. Ninety patients with craniocerebral injury were divided into high coagulation group （n=50）， low coagulation group （n=11） and normal group （n=29） by TEG comprehensive coagulation index （CCI）. The severity of craniocerebral injury was assessed by Glasgow coma index （GCS） score in 90 patients， who were divided into severe group （n=32）， moderate group （n=42） and mild group （n=16）. Plasma prothrombin time （PT）， thrombin time （TT）， activated partial thrombin time （APTT）， fibrin degradation product （FDP） and D-dimer （D-D） were detected. TEG reaction time （R）， coagulation time （K）， maximum thrombus size （Ma）， coagulation angle （α）， clot strength （G） and coagulation composite index （CCI） of TEG were measured. TEG and clotting test results were compared. Results The R and K time of the high coagulation group were significantly shorter than those of the low coagulation group and the normal group， and the differences were statistically significant （P<0.05）. Ma， α and G in the high coagulation group were significantly higher than those in the low coagulation group and the normal group， and the differences were statistically significant （P<0.05）. FDP in the hypercoagulation group was significantly higher than that in the normal group， and the difference was statistically significant （P<0.05）. The D-D of the high-coagulation group was significantly higher than that of the low-coagulation group and the normal group， and the differences were statistically significant （P<0.05）. R and K time of the severe group were significantly shorter than those of the mild group， and the differences were statistically significant （P<0.05）. Ma， α， G， D-D in the severe group were significantly higher than those in the moderate group and mild group， and the differences were statistically significant （P<0.05）. Conclusion Compared with the conventional coagulation indexes， the TEG can better distinguish the severity of emergency craniocerebral injury and understand the status of coagulation function more quickly and accurately.