血栓弹力图联合凝血指标对早期急性胰腺炎严重程度评估的临床意义

目的 探讨血栓弹力图(thrombelastograph,TEG)联合常规凝血指标在急性胰腺炎(acute pancreatitis,AP)发病早期临床救治中对病情严重程度评估的意义.方法 选取 2015年8月至2016年8月兰州军区兰州总医院发病24 h内收治的急性胰腺炎患者73例为研究对象.依据中华医学会急性胰腺炎诊治指南(2014版)将患者分为轻症组33例(MAP组)、中重症组26例(MSAP组)和重症组14例(SAP组).完善相关检查,检测常规凝血功能指标活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(DD)],描绘TEG血凝时间(R)、血块成型时间(K)、α角、血块强度(MA)].记录24h急性生理与慢性健康评分Ⅱ(acute physiology and shronic health evalu-ationⅡ,APACHEⅡ)及48 h改良Marshall评分,分析监测指标在3组中的变化.结果 中重症组较轻症组PT、APTT、FIB、DD的水平轻度升高(P＞0.05);与中重症组及轻症组比较,重症组PT、APTT、FIB和D-D均显著升高(P＜0.05).3 组R值、K值、α角和MA值比较,差异均有统计学意义(P＜0.05);其中,重症组R值、K值较中重症组和轻症组缩短,重症组α角、MA值大于中重症组和轻症组,差异有统计学意义(P＜0.05);中重症组R值、K值较轻症组缩短,中重症组α角、MA值大于轻症组,差异有统计学意义(P＜0.05).TEG和APACHⅡ及Marshall评分系统相关性分析:APACHⅡ及Marshall评分和R值及K值呈负相关(r=-0.127,-0.238,-0.459,-0.213);和α角、MA值呈正相关(r=0.439,0.267,0.379,0.136),差异有统计学意义(P＜0.05).结论 TEG联合凝血指标可较真实地判断AP患者早期凝血纤溶状态,更准确地预测AP发病早期的严重程度,对临床救治有一定的指导意义.

Clinical significance of TEG combined coagulation testsin evaluating severity of illness in early acute pancreatitis

Objective To investigate the value of thrombelastograph(TEG)combined coagulation test in evaluating severity of illness in early acute pancreatitis(AP).Methods From August 2015 to August 2016,73 cases of acute pancreatitis with onset less 24 hours were studied.The patients were divided into three groups according to the guidelines for the diagnosis and treatment of AP in Chinese medical association: mild acute pancreatitis(MAP,n=33),moderately severe acute pancreatitis(MSAP,n=26)and severely acute pancreatitis(SAP,n=14).All patients were determined by coagulation tests activated partial thromboplastin time(APTT),prothrombin(PT),fibrinogen(FIB)and D-Dimmer(D-D)] and TEG(reaction time(R),kinetics of clot development(K),α angle and maximum amplitude(MA)simultaneously.While recording acute physiology and shronic health evaluationⅡ(APACHEⅡ)of the patient admitted in 24 hours and Mashall score of the patient admitted in 48 h.The difference and relativity of monitoring index in the three groups were analyzed.Results The value of PT,APTT,FIB and DD in MSAP group were larger than those in MAP group,but there was no significant differences(P＞0.05).While the value of PT,APTT,FIB and DD in SAP group were much larger than those in MAP and MSAP groups(P＜0.05).Compared with MSAP and MAP groups,the value of R and K in SAP group significantly decreased,and the value of a angle and MA obviously increased(P＜0.05).The value of APACHⅡ and Marshall had the negative correlation with R and K(r=-0.127,-0.238,-0.459,-0.213),and had positive correlation with α angle and MA(r=0.439,0.267,0.379,0.136).Conclusion TEG combined conventional coagulation test could comparatively accurately eval-uate the coagulation and fibrinolysis state of patients with AP,and assess the severity in early stage.It`s helpful to clinical care for AP.