血栓弹力图在急诊颅脑损伤患者凝血功能障碍及病情程度判断中的应用价值

邹海军 陈晨 李天星

[摘要]目的 探討血栓弹力图（TEG）在急诊颅脑损伤患者凝血功能障碍及病情程度中的判断价值。方法 将佛山市三水区人民医院急诊科2016年1月～2017年6月收治的90例急诊颅脑损伤患者作为研究对象，90例颅脑损伤患者经TEG的凝血综合指数（CCI）判断后，将患者分为高凝组（n=50）、低凝组（n=11）、正常组（n=29）。90例颅脑损伤患者经格拉斯哥昏迷指数（GCS）评分评定颅脑损伤病情程度，将患者分为重度组（n=32），中度组（n=42），轻度组（n=16）。分别检测血浆凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白降解产物（FDP）及D-二聚体（D-D）水平，测量TEG的反应时间（R）、凝固时间（K）、血栓最大幅度（Ma）、凝固角（α）、凝血块强度（G）及凝血综合指数（CCI），对比TEG与凝血检测结果。结果 高凝组的R、K时间显著短于低凝组及正常组，差异有统计学意义（P<0.05）；高凝组的Ma、α、G显著高于低凝组及正常组，差异有统计学意义（P<0.05）；高凝组的FDP显著高于正常组，差异有统计学意义（P<0.05）；高凝组的D-D显著高于低凝组及正常组，差异有统计学意义（P<0.05）；重度组的R、K时间显著短于轻度组，差异有统计学意义（P<0.05）；重度组的Ma、α、G、D-D显著高于中度及轻度组，差异有统计学意义（P<0.05）。结论 血栓弹力图与常规凝血指标比较，可更好地区分急诊颅脑损伤的病情程度，可更快及准确地了解凝血功能状况。

[关键词]急诊颅脑损伤；血栓弹力图；凝血功能障碍；病情程度

[中图分类号] R457.1 [文献标识码] A [文章编号] 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.