血栓弹力图与凝血功能检查评估ICU重症多发伤出血预后的研究

摘要

目的 探讨血栓弹力图与凝血功能检查对ICU重症多发伤出血患者预后的预测价值.方法 2015年1月至2018年1月ICU重症多发伤出血患者130例,所有患者入院当天均接受血栓弹力图与凝血功能检查,根据患者1个月内的预后情况分成死亡组、存活组,比较两组血栓弹力图指标与凝血功能指标,其中血栓弹力图指标包括凝血反应时间(R时间)、凝固时间(K时间)、最大振幅(MA)与凝固角(α角),凝血功能指标包括血浆凝血酶原时间(PT)、血浆纤维蛋白原(FIB)、血小板计数(PLT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D).通过绘制受试者工作特征曲线(ROC)分析各指标对ICU重症多发伤出血患者预后的预测价值.结果 ICU重症多发伤出血患者130例,38例死亡,占29.23%,92例存活,占70.77%.存活组R时间、K时间较死亡组明显缩短,且MA、α角高于死亡组,差异有统计学意义(P<0.05).存活组PT、APTT、D-D低于对照组,且FIB、PLT高于对照组,差异有统计学意义(P<0.05).ROC曲线提示R时间、K时间、MA、α角预测患者短期死亡的曲线下面积分别为0.672、0.770、0.779、0.726.PT、FIB、PLT、APTT、D-D预测患者短期死亡的曲线下面积分别为0.692、0.655、0.672、0.691、0.674.结论 血栓弹力图与凝血功能检查均对ICU重症多发伤出血患者的预后具有预测价值,其中血栓弹力图的预测效果更好.%Objective To explore the predictive value of thrombelastogram and coagulation function in the prognosis of severe multiple trauma patients with ICU bleeding. Methods 130 patients with severe multiple injury hemorrhage of ICU admitted to our hospital from January 2015 to January 2018. All patients received thrombus elastography and coagulation function examination on the day of admission were divided into the death group and the survival group according to the prognosis within one month.The indexes of thrombus elastography and coagulation function were compared between the two groups. Thromboelastograph included coagulation reaction time(R time),coagulation time(K time),maximum amplitude(MA)and coagulation angle(alpha angle).The indexes of coagulation function include plasma prothrombin time(PT),plasma fibrinogen(FIB),platelet count(PLT),activated partial thromboplastin time(APTT),D-dimer(D-D).The predictive value of each index for the prognosis of ICU patients with severe multiple trauma bleeding was analyzed by drawing the receiver operating characteristic curve(ROC). Results Among 130 patients with severe multiple injury hemorrhage in ICU,38 died,accounted for 29.23%,92 survived,accounted for 70.77%. The R time and K time of the survival group were significantly shorter than the death group,and the MA and q angles were higher than the death group(P<0.05). The PT,APTT and d-d in the survival group were smaller than those in the control group,and FIB and PLT were higher than those in the control group.The difference was statistically significant(P<0.05).The ROC curve indicated that the area under the curve of R time,K time,MA and alpha angle in predicting short-term death were 0.672,0.770,0.779 and 0.726 respectively.The area under the curve of PT,FIB,PLT,APTT and D-D in predicting the short-term mortality of patients were 0.692,0.655,0.672,0.691 and 0.674 respectively. Conclusion Thrombelastogram and coagulation function have predictive value for the prognosis of ICU patients with severe multiple trauma bleeding,and thrombelastogram has better prediction effect.