血栓弹力图及常规凝血功能与多发伤患者创伤严重程度的研究

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摘要目的探讨血栓弹力图(thrombelastography，TEG)及常规凝血功能变化与多发伤患者创伤严重程度的临床关系。方法选取山西医科大学附属大医院急诊科自2018年4月至11月收治的126例多发伤患者，分别计算各自入院时的坎特拉创伤评分(kampala trauma score，KTS)，根据KTS评分将126例多发伤患者分为轻型组、中型组、重型组，于伤后12 h内行TEG及常规凝血检查，另选取同期30名健康体检组作为对照组，观察四组各项实验参数的差异；同时分析两种检查方法各项参数的相关性。结果四组常规凝血检查Fib、D-二聚体、血小板计数(platelet count，PLT)比较差异均有统计学意义；四组TEG指标比较仅MA值差异有统计学意义；TEG参数与常规凝血检查指标相关性分析：R值与凝血酶原时间(prothrombin time，PT)、活化部分凝血活酶时间(activated partial thromboplastin time，APTT)呈正相关，与Fib呈负相关；K值与APTT、凝血酶时间(thrombin time，TT)呈正相关，与Fib、PLT呈负相关；α角与Fib、D-二聚体、PLT呈正相关，与PT、APTT、TT呈负相关；MA值与Fib、PLT呈正相关，与PT呈负相关。结论不同创伤程度多发伤患者早期凝血功能障碍表现存在多样性；联合应用TEG和常规凝血检查可全面评估多发伤患者早期凝血功能障碍。

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	黄静 1
	闫新明 2*

关键词 ：血栓弹力图, 凝血功能障碍, 多发伤, 创伤严重程度, 坎特拉创伤评分

Abstract：Objective To explore the clinical relationship between thromboelastogram，routine coagulation function and severity of trauma in patients with multiple trauma. Methods 126 patients with multiple injuries were selected from the Emergency Department of the Affiliated Hospital of Shanxi Medical University from April to November，2018.126 patients were divided into light group，medium group and heavy group according to Kampala trauma score at admission.TEG and routine coagulation tests were performed within 12 hours after injury.Another 30 healthy people in the same period were selected as control group to observe the differences of the experimental parameters of the four groups.The correlation between the parameters of the two methods was also analyzed.Results There were significant differences in fibrinogen，D-dimer and platelet counts between the four groups in routine coagulation tests.There was only significant difference in MA value between the four groups in TEG indexes.The correlation analysis between TEG parameters and routine coagulation indexes showed that R value was positively correlated with prothrombin time and activated partial thromboplastin time.K value was positively correlated with APTT and thrombin time，negatively correlated with Fib and PLT；alpha angle was positively correlated with Fib，D-dimer and PLT，negatively correlated with PT，APTT and TT；MA value was positively correlated with Fib and PLT，and negatively correlated with PT.Conclusion Early coagulation dysfunction in patients with multiple trauma of different degrees is diverse.Combined application of TEG and routine coagulation examination can comprehensively evaluate early coagulation dysfunction in patients with multiple trauma.

Key words： thrombelastography coagulation dysfunction multiple trauma severity of traum kampala trauma score

通讯作者: 闫新明

作者简介: 黄静(1991－ )，女，研究生在读，山西医科大学，030001。

引用本文:

黄静 1，闫新明 2*. 血栓弹力图及常规凝血功能与多发伤患者创伤严重程度的研究[J]. 实用骨科杂志, 2019, 25(9): 804-829.
Huang Jing 1，Yan Xinming 2*. Study on Thromboelastography and Routine Coagulation Function and Severity of Trauma in Patients with Multiple Trauma. sygkzz, 2019, 25(9): 804-829.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I9/804

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