早期血栓弹力图指导输血对严重颅脑创伤患者的影响

目的探讨早期血栓弹力图指导严重颅脑创伤合并凝血功能障碍患者输血治疗对24 h输注血液制品、入住ICU时间和预后的影响。方法选取124例严重颅脑创伤合并凝血功能障碍患者,依据随机化原则分为2组,研究组64例依据血栓弹力图联合常规凝血指导输血治疗,对照组60例依据常规凝血指导输血治疗。2组分别比较入住ICU后8 h、16 h、24 h内输注新鲜冰冻血浆、红细胞、血小板、冷沉淀、晶体液和凝血功能障碍纠正人数之间是否存在差异,比较2组入住ICU时间及1个月后的格拉斯哥预后评分之间是否存在差异。结果研究组入住ICU后8 h内输注新鲜冰冻血浆、血小板、冷沉淀量及凝血功能障碍纠正人数较对照组明显增多(P<0.05),输注红细胞、晶体液无显著性差异;研究组入住ICU 16 h内输注新鲜冰冻血浆、红细胞、冷沉淀量较明显少于对照组(P<0.05),凝血功能障碍纠正人数较对照组明显增多(P<0.05),输注血小板、晶体液无显著差异;研究组入ICU 24 h内输注新鲜冰冻血浆、红细胞、冷沉淀量明显少于对照组(P<0.05),输注血小板、晶体液量及凝血功能障碍纠正人数显著性学差异;研究组入住ICU时间较对照组明显缩短(P<0.05),1个月后的格拉斯哥预后评分较对照组明显改善(P<0.05)。结论早期血栓弹力图指导输血可以更早的改善重度颅脑损伤患者的凝血功能障碍,减少严重颅脑创伤合并凝血功能障碍患者的血液制品输注,缩短入住ICU时间,改善预后。

The effect of early thromboelastography on blood transfusion for the patients with severe craniocerebral trauma

Objective To explore the effects of early thrombelastography on blood transfusion in 24h,crystalloids utilization in 24h,intensive care unit length of stay,and prognosis for severe craniocerebral trauma patients with coagulationdisorders.Methods The control group was the patients with blood transfusion guiding by routine coagulation monitoring.The study group was guiding by early thrombelastography and routine coagulation monitoring.Comparing the difference between the two groups within 8h,16h and 24h in the ICU on transfusion of blood plasma,red blood cells,platelets,cold precipitation,crystalloidsl,ICU length of stay,and glasgow prognostic score one month later.Results Compared to the control group,the study group patients in the ICU within 8 hours on transfusion of blood plasma,infusion platelet,cold precipitation and improvement in coagulation function were significantly increased(P<0.05).There was no statistically significant difference between red blood cells and crystalloids within 8 hours into the ICU(P≥0.05).The study group patients in the ICU within 16 hours on transfusion of blood plasma,red blood cells,cold precipitation were significantly reduced(P<0.05).Improvement in coagulation function was significantly increased(P<0.05).There was no statistically significant difference between infusion platelet and crystalloids within 16 hours into the ICU(P≥0.05).The study group patients in the ICU within 24 hours on transfusion of blood plasma,red blood cells,cold precipitation were significantly reduced(P<0.05).There was no statistically significant difference between infusion platelet,crystalloids and improvement in coagulation function within 24 hours into the ICU(P≥0.05).The ICU length of stay was obviously shortened(P<0.05);There was significant difference on glasgow prognostic score one month later(P<0.05).Conclusion Early thromboelastography monitoring can reduce blood transfusion in patients with severe craniocerebral trauma,shorten ICU length of stay and improve its prognosis.