血栓弹力图在脓毒症患者病情评估中的作用研究

目的研究血栓弹力图(TEG)在脓毒症患者病情评估的价值。方法回顾性分析中山大学孙逸仙纪念医院重症医学科2017年4月至2017年11月的脓毒症患者57例,根据SOFA评分分为A组(SOFA≥10分)(26例)和B组(10分SOFA≥2分)(31例),另外选择同期非脓毒症且凝血功能正常患者作为对照组C组(43例)。取静脉血检测TEG,分析比较各组间各项TEG检测指标。结果各组TEG检查结果比较,凝血反应时间(R值)和凝血酶形成时间(K值):A组C组B组,结果有统计学意义P0.05;纤维蛋白凝块形成及加固的速率(α角)和血凝块最大强度和硬度(MA值):A组C组B组,结果有统计学意义P0.05。R值、K值与SOFA评分呈正相关(均P0.05),α角、MA值与SOFA评分呈负相关(均P0.05),B组患者28天死亡率为12.9%,随SOFA评分升高,A组患者28天死亡率高达46.1%。结论血栓弹力图能较全面、准确地分析脓毒症患者凝血状态,与SOFA评分存在一定相关性,血栓弹力图监测对评价脓毒症患者严重程度及指导治疗有重要意义。

Study on the role of thromboelastography in evaluating the condition of patients with sepsis

［Abstract］ Objective To study the value of thromboelastography（TEG）in the evaluation of sepsis. Methods Fifty?five patients with sepsis from April 2017 to November 2017 in the Department of Critical Care Medicine of Sun Yat?sen Memorial Hospital, Sun Yat?sen University were analyzed retrospectively. According to the SOFA score, the patients were divided into Group A（SOFA score≥ 10）（26 cases）and Group B （10>SOFA score≥2）（31 cases）. Another 43 cases with non?sepsis and normal coagulation function were selected as a control group（Group C）. The venous blood was collected for TEG, and then analysis and comparison of various TEG indicators between groups. Results The time of coagulation reaction（R value）and thrombin formation（K value）were compared in each group：Group A > Group C > Group B, the results were statistically significant （P<0.05）, the rate of fibrin clot formation and reinforcement（α Angle）and the maximum strength and hardness of blood clot（MA value）：Group A < Group C < Group B, the results were statistically significant （P<0.05）. R and K value were positively correlated with the SOFA score （All P values <0.05）, and α Angle, MA value were significantly negatively correlated with the SOFA score（All P values <0.05）. The 28?day mortality rate of Group B was 12.9% and with the increase of SOFA score, the 28?day mortality rate of Group A was 46.1%. Conclusion Thromboelastography can analyze the coagulation status of sepsis patients comprehensively and accurately, and there is a significant correlation with SOFA score. Monitoring the thromboelastography is of great significance to evaluate the severity of sepsis patients and guide the treatment.