Early evaluation of acute traumatic coagulopathy by thrombelastography
Early evaluation of acute traumatic coagulopathy by thrombelastography
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DOI：
10.1016/j.trsl.2009.04.001
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发表时间：
2009-07-01
影响因子：
7.8
通讯作者：
Kurek, Stanley J.
中科院分区：
文献类型：
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作者：
Carroll, Roger C.;Craft, Robert M.;Kurek, Stanley J.
创伤后凝血病是发病的主要原因。这项前瞻性研究评估了血栓弹力图 (TEG) 系统和血小板图谱（Haemscope Corporation，Niles，III）的创伤后值，并将这些值与输血和死亡相关联。经机构审查委员会批准后，对 161 名创伤患者进行了检测。现场采集一份柠檬酸盐血样 (OS)，并在到达急诊室 (ED) 后 1 小时内采集 1 份柠檬酸盐样品和 1 份肝素化样品。对标称数据进行配对和非配对 t 检验，对分类值进行卡方检验。除了血块强度（最大振幅 (MA)）略有增加外，从 OS 到 ED 没有显着变化。 22 名需要输血的患者的 TEG 参数均无显着差异。血小板图谱显示需要输血的患者血小板二磷酸腺苷 (ADP) 反应性较低（MA = 22.7 +/- 17.1 vs MA = 35.7 +/- 19.3，P = 0.004），纤维蛋白原 < 100 mg/dL 与死亡相关（P = 0.013）。对于 14 例死亡病例，TEG 反应 (R) 时间分别为 3703 +/- 11,618 秒和 270 +/- 393 秒 (P = < 0.001)，MA 分别为 46.4 +/- 22.4 和 64.7 +/- 9.8 毫米 (P < 0.001)。在急诊科的 3 名患者中观察到纤溶亢进（60 分钟后纤溶百分比 (LY60) > 15%），死亡率为 67%（卡方检验 P = < 0.001）。血小板图分析与输血需求相关。 TEG系统参数异常与死亡相关。这些凝血病已经在 OS 中表现得很明显。 TEG 检测可以评估创伤后早期的凝血功能障碍、血小板功能障碍和纤溶亢进，并提出更有效的干预措施。 （转化研究 2009 年；154：34-39）
Posttraumatic coagulopathy is a major cause of morbidity. This prospective study evaluated the thrombelastography (TEG) system and PlateletMapping (Haemoscope Corporation, Niles, III) values posttrauma, and it correlated those values with transfusions and fatalities. After institutional review board approval, assays were performed on 161 trauma patients. One citrated blood sample was collected onsite (OS), and 1 citrate and 1 heparinized sample were collected within 1 h of arrival to the emergency department (ED). Paired and unpaired t-testing was performed for nominal data with chi square testing for categorical values. Except for a slight increase in clot strength (maximal amplitude (MA)), there were no significant changes from OS to the ED. None of the TEG parameters were significantly different for the 22 patients who required transfusion. PlateletMapping showed lower platelet adenosine diphosphate (ADP) responsiveness in patients who needed transfusions (MA = 22.7 +/- 17.1 vs MA = 35.7 +/- 19.3, P = 0.004) and a correlation of fibrinogen < 100 mg/dL with fatalities (P = 0.013). For the 14 fatalities, TEG reaction (R) time was 3703 +/- 11,618 versus 270 +/- 393 s (P = < 0.001), and MA was 46.4 +/- 22.4 versus 64.7 +/- 9.8 mm (P < 0.001). Hyperfibrinolysis (percent fibrinolysis after 60 min (LY60) > 15%) was observed in 3 patients in the ED with a 67% fatality rate (P = < 0.001 by chi-square testing). PlateletMapping assays correlated with the need for blood transfusion. The abnormal TEG System parameters correlated with fatality. These coagulopathies were already evident OS. The TEG assays can assess coagulopathy, platelet dysfunction, and hyperfibrinolysis at an early stage posttrauma and suggest more effective interventions. (Translational Research 2009; 154:34-39)