Comprehensive Coagulation Profiling at the Point-of-Care Using a Novel Laser-Based Approach.
Comprehensive Coagulation Profiling at the Point-of-Care Using a Novel Laser-Based Approach.
复制标题
使用新型激光方法在护理点进行全面的凝血分析。
DOI：
10.1055/s-0039-1683842
复制
发表时间：
2019
影响因子：
5.7
通讯作者：
Nadkarni,SeemantiniK
中科院分区：
文献类型：
--
作者：
Nadkarni,SeemantiniK
延迟识别内出血会危及生命，因此强调需要在床边进行快速、全面的凝血分析。作者综述了一种新型光学凝血分析仪，该分析仪使用单一多功能仪器测量多种凝血指标，包括凝血酶原时间、活化凝血时间、凝块聚合率（α 角）、凝块硬度（最大振幅）、纤维蛋白溶解 (LY) 和血小板功能。光学轮廓仪基于激光散斑流变学原理，通过称为激光散斑的光散射图案来量化组织粘弹性。为了操作光学轮廓仪，将全血 (40 μL) 装入一次性盒中，通过相机记录激光散斑图案，并根据散斑强度波动估计凝血的粘弹性。通过监测凝块起始、凝血酶生成、纤维蛋白交联、凝块稳定和 LY 过程中粘弹性模量随时间的变化，使用一滴全血在 10 分钟内获得总体凝血参数。迄今为止，对 500 多名患者进行的临床测试已证实光学轮廓仪相对于传统凝血测试和血栓弹力图全面评估凝血状态的准确性。最近的研究进一步证明了在没有施加剪切应力的情况下量化一滴富含血小板血浆中二磷酸腺苷诱导的血小板聚集的能力。总之，这些研究表明，除了血小板功能之外，还可以使用单个多功能设备来完成整体凝血分析。因此，通过在床边实现快速、全面的凝血和血小板功能分析，光学分析仪可能会提高识别和管理出血风险较高患者的能力。
Delays in identifying internal bleeding are life-threatening, thus underscoring the need for rapid and comprehensive coagulation profiling at the bedside. The authors review a novel optical coagulation profiler that measures several coagulation metrics including prothrombin time, activated clotting time, clot polymerization rate (α-angle), clot stiffness (maximum amplitude), fibrinolysis (LY), and platelet function, using a single multifunctional instrument. The optical profiler is based on the principles of Laser Speckle Rheology that quantifies tissue viscoelasticity from light scattering patterns called laser speckle. To operate the optical profiler, whole blood (40 μL) is loaded into a disposable cartridge, laser speckle patterns are recorded via a camera, and the viscoelasticity of clotting blood is estimated from speckle intensity fluctuations. By monitoring alterations in viscoelastic moduli over time during clot initiation, thrombin generation, fibrin crosslinking, clot stabilization, and LY, global coagulation parameters are obtained within 10 minutes using a drop of whole blood. Clinical testing in over 500 patients to date has confirmed the accuracy of the optical profiler for comprehensively assessing coagulation status against conventional coagulation tests and thromboelastography. Recent studies have further demonstrated the capability to quantify platelet aggregation induced by adenosine diphosphate in a drop of platelet-rich-plasma in the absence of applied shear stress. Together, these studies demonstrate that global coagulation profiling in addition to platelet function may be accomplished using a single multifunctional device. Thus, by enabling rapid and comprehensive coagulation and platelet function profiling at the bedside, the optical profiler will likely advance the capability to identify and manage patients with an elevated risk for hemorrhage.