Thrombelastography (TEG®): practical considerations on its clinical use in trauma resuscitation.
Thrombelastography (TEG®): practical considerations on its clinical use in trauma resuscitation.
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DOI：
10.1186/1757-7241-21-29
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发表时间：
2013-04-16
期刊：
影响因子：
--
通讯作者：
Rizoli S
中科院分区：
文献类型：
--
作者：
da Luz LT;Nascimento B;Rizoli S
血栓弹力图是一种实验室测试，测量整个凝血过程的粘弹性变化。其在创伤复苏中的临床应用越来越受到关注，特别是用于管理创伤的急性凝血病和辅助有关输血的决策。本文综述了血栓弹力描记术在创伤中的临床应用，并就其在民用和军事环境中的应用提出了一些实际问题。在PUBMED数据库中使用术语“血栓弹力图和创伤”进行文献检索。我们集中审查的主要临床方面，这种粘弹性方法在诊断和治疗患者的急性凝血功能障碍的创伤在初始复苏。血栓弹力图不能替代传统的实验室检查，如INR和aPTT，但可以提供额外的信息，并可以指导输血。血栓弹力图可用作床旁检测，但需要每日多次校准，应由经过培训的人员进行，其技术需要标准化。虽然有用的部分结果可能在几分钟内即可获得，但整个测试可能需要与其他传统测试一样长的时间。血栓弹力图提供的最重要的数据是凝块强度和纤维蛋白溶解。血凝块强度测量可以确定出血是否由凝血功能障碍引起，并且是基于血栓弹力图的输血算法中的关键信息。血栓弹力图是为数不多的诊断和量化纤维蛋白溶解的测试之一，从而指导抗纤维蛋白溶解药物和血液制品（如冷沉淀和纤维蛋白原浓缩物）的使用。它还可以诊断血小板功能障碍和高凝状态，并可能防止向非凝血病患者不适当地输注止血血液制品。血栓弹性描记术具有理想的凝血试验特点，可用于创伤早期复苏。它有局限性，但可能被证明是有用的，作为一个额外的测试。未来的研究应评估其指导输血的潜力和对创伤凝血功能障碍机制的理解。
Thrombelastography is a laboratorial test that measures viscoelastic changes of the entire clotting process. There is growing interest in its clinical use in trauma resuscitation, particularly for managing acute coagulopathy of trauma and assisting decision making concerning transfusion. This review focuses on the clinical use of thrombelastography in trauma, with practical points to consider on its use in civilian and military settings. A search in the literature using the terms “thrombelastography AND trauma” was performed in PUBMED database. We focused the review on the main clinical aspects of this viscoelastic method in diagnosing and treating patients with acute coagulopathy of trauma during initial resuscitation. Thrombelastography is not a substitute for conventional laboratorial tests such as INR and aPTT but offers additional information and may guide blood transfusion. Thrombelastography can be used as a point of care test but requires multiple daily calibrations, should be performed by trained personnel and its technique requires standardization. While useful partial results may be available in minutes, the whole test may take as long as other conventional tests. The most important data provided by thrombelastography are clot strength and fibrinolysis. Clot strength measure can establish whether the bleeding is due to coagulopathy or not, and is the key information in thrombelastography-based transfusion algorithms. Thrombelastography is among the few tests that diagnose and quantify fibrinolysis and thus guide the use of anti-fibrinolytic drugs and blood products such as cryoprecipitate and fibrinogen concentrate. It may also diagnose platelet dysfunction and hypercoagulability and potentially prevent inappropriate transfusions of hemostatic blood products to non-coagulopathic patients. Thrombelastography has characteristics of an ideal coagulation test for use in early trauma resuscitation. It has limitations, but may prove useful as an additional test. Future studies should evaluate its potential to guide blood transfusion and the understanding of the mechanisms of trauma coagulopathy.
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影响因子：
9
作者：
Kashuk, Jeffry L.;Moore, Ernest E.;Sauaia, Angela
通讯作者：
Sauaia, Angela
影响因子：
2.9
作者：
Kashuk, Jeffry L.;Moore, Ernest E.;Sauaia, Angela
通讯作者：
Sauaia, Angela
影响因子：
3.1
作者：
Harr, Jeffrey N.;Moore, Ernest E.;Silliman, Christopher C.
通讯作者：
Silliman, Christopher C.
影响因子：
7.8
作者：
Carroll, Roger C.;Craft, Robert M.;Kurek, Stanley J.
通讯作者：
Kurek, Stanley J.
DOI：
10.1097/ta.0b013e31819d3caf
发表时间：
2009-04-01
影响因子：
--
作者：
Jeger, Victor;Zimmermann, Heinz;Exadaktylos, Aristonenis K.
通讯作者：
Exadaktylos, Aristonenis K.