危重烧伤患者血栓弹力图、凝血指标及血小板变化的临床意义

范宝玉　王娟　赵海磊

【摘要】 目的：研究危重燒伤患者血栓弹力图、凝血指标及血小板变化的临床意义。方法：回顾性分析本院烧伤科在2015年10月-2016年10月收治的50例危重烧伤患者临床资料作为研究对象，将其作为观察组，在患者烧伤后3 d内的渗出期对患者的血栓弹力图（TEG）、血小板（PLT）及凝血指标进行检测，在患者渗出期过后并且全身情况稳定之后进行扩张器与皮瓣联合治疗创面，在手术前检测患者的血栓弹力图、凝血指标及血小板水平。另外选择2015年10月-2016年10月在本院进行健康体检的50例健康人员作为对照组。观察比较两组的血栓弹力图、凝血指标及血小板水平。结果：与对照组比较，观察组患者渗出期的R值、K值及PLT均明显减小，CI值和α角均明显增加，差异均有统计学意义（P<0.05）；两组的凝血指标比较，差异均无统计学意义（P>0.05）。观察组患者手术前的MA值、R值、PLT、Fb均高于渗出期，TT短于渗出期，差异均有统计学意义（P<0.05）。观察组患者渗出期的α角和PLT、Fb均呈正相关（P<0.05）；R值和APTT呈正相关（P<0.05）；MA值和Fb、PLT均存在正相关（P<0.05）；MA值和TT存在负相关（P<0.05）；K值和Fb、PLT均呈正相关（P<0.05）；CI值和APTT、Fb均呈正相关（P<0.05）。结论：危重烧伤患者的凝血功能会出现一定的变化及异常，血栓弹力图和血小板变化及凝血指标具有一定的相关性，三者具有一定的互补作用，对危重烧伤患者凝血功能的全面评估及输血指导、出血风险的判断具有重要的现实意义。

【关键词】 危重烧伤； 血栓弹力图； 凝血指标

Clinical Significance of Thromboelastogram，Coagulation Indexes and Platelet Changes in Critically Burned Patients/FAN Baoyu，WANG Juan，ZHAO Hailei.//Medical Innovation of China，2018，15（06）：103-106

【Abstract】 Objective：To study the clinical significance of thromboelastography，coagulation index and platelet change in patients with severe burn.Method：The clinical data of 50 patients with severe burns admitted in our hospital from October 2015 to October 2016 were retrospectively analyzed，as the observation group，the thromboelastogram （TEG），platelet thromboplastin （PLT） and coagulation parameters were detected during the exudation period within 3 days after burn，after the exudation period and the stability of the whole body，the wound was treated by the expander combined with the flap，thromboelastogram，coagulation index and platelet level were measured before operation.50 healthy people were enrolled in our hospital from October 2015 to October 2016，as the control group.Thromboelastogram， coagulation index and platelet level were observed and compared between the two groups.Result：Compared with the control group，the R value，K value and PLT of the patients in the observation group were significantly decreased，CI value and α angle were increased，the differences were statistically significant（P<0.05）；there were no significant differences in coagulation indexes between the two groups（P>0.05）.In the observation group，the values of MA and R before operation were significantly higher than those in the control group，TT was shorter than that of exudative phase，the differences were statistically significant（P<0.05）.In the exudation period，at the observation group there were positive correlations between α angle and PLT，Fb（P<0.05）；R value was positively correlated with APTT（P<0.05）；there were positive correlations between MA value and Fb，PLT（P<0.05）；there was a negative correlation between MA and TT（P<0.05）；K value was positively correlated with Fb and PLT（P<0.05）；there were positive correlations between CI and APTT，Fb（P<0.05）.Conclusion：The coagulation function of severe burn patients will be changed and abnormal，thromboelastogram and platelet changes and coagulation indicators have a certain correlation，the three have a certain complementary role，it is of practical significance to evaluate the coagulation function of severe burn patients，to guide blood transfusion and to judge the risk of bleeding.

【Key words】 Severe burn； Thrombus stretch chart； Clotting index

First-authors address：Beijing Chaoyang District Emergency Medical Center，Beijing 100122，China

doi：10.3969/j.issn.1674-4985.2018.06.029

烧伤患者因为自身机体凝血抗凝系统的动态平衡能力受到破坏，患者的凝血功能会出现障碍，从而导致患者引发炎症，并且产生弥散性血管内凝血（DIC）、休克、多器官功能障碍综合征（MODS）或者全身性炎性反应综合征，严重还会导致患者死亡，所以对患者的凝血指标及血小板变化进行全面的研究具有重要的临床作用。常规血小板计数及凝血实验只能对患者凝血体系部分进行检测[1]，并不能够对整个纤溶过程及凝血进行全面的评估。血栓弹力图（TEG）能够对患者血液凝固及溶解过程进行全面的分析，并且通过图形形式将其反映出来[2]。……