入院时快速血栓弹力描记术可预测创伤患者发生肺栓塞的风险。
Admission rapid thrombelastography predicts development of pulmonary embolism in trauma patients.
机构信息
Department of Surgery, The University of Texas Health Science Center, Houston, Texas 77030, USA.
出版信息
J Trauma Acute Care Surg. 2012 Jun;72(6):1470-5; discussion 1475-7. doi: 10.1097/TA.0b013e31824d56ad.
BACKGROUND
Injury leads to dramatic disturbances in coagulation with increased risk of bleeding followed by a hypercoagulable state. A comprehensive assessment of these coagulation abnormalities can be measured and described by thrombelastography. The purpose of this study was to identify whether admission rapid-thrombelastography (r-TEG) could identify patients at risk of developing pulmonary embolism (PE) during their hospital stay.
METHODS
Patients admitted between September 2009 to February 2011 who met criteria for our highest-level trauma activation and were transported directly from the scene were included in the study. PE defined as clinically suspected and computed tomography angiography confirmed PE. We evaluated r-TEG values with particular attention to the maximal amplitude (mA) parameter that is indicative of overall clot strength. Demographics, vital signs, injury severity, and r-TEG values were then evaluated. In addition to r-TEG values, gender and injury severity score (ISS) were chosen a priori for developing a multiple logistic regression model predicting development of PE.
RESULTS
r-TEG was obtained on 2,070 consecutive trauma activations. Of these, 2.5% (53) developed PE, 97.5% (2,017) did not develop PE. Patients in the PE group were older (median age, 41 vs. 33 years, p = 0.012) and more likely to be white (69% vs. 54%, p = 0.036). None of the patients in the PE group sustained penetrating injury (0% vs. 25% in the no-PE group, p < 0.001). The PE group also had admission higher mA values (66 vs. 63, p = 0.050) and higher ISS (median, 31 vs. 19, p = 0.002). When controlling for gender, race, age, and ISS, elevated mA at admission was an independent predictor of PE with an odds ratio of 3.5 for mA > 65 and 5.8 for mA > 72.
CONCLUSION
Admission r-TEG mA values can identify patients with an increased risk of in-hospital PE. Further studies are needed to determine whether alternative anticoagulation strategies should be used for these high-risk patients.
LEVEL OF EVIDENCE
Prognostic study, level III.
背景
损伤会导致凝血明显紊乱，出血风险增加，随后出现高凝状态。血栓弹力描记术可全面评估这些凝血异常，并对其进行测量和描述。本研究旨在确定入院时快速血栓弹力描记术（r-TEG）是否能识别住院期间发生肺栓塞（PE）的高危患者。
方法
纳入 2009 年 9 月至 2011 年 2 月间因符合我们最高级别创伤激活标准且直接从现场转运来院的患者。临床疑诊 PE 并经 CT 血管造影（CTA）证实的患者被定义为 PE。我们评估了 r-TEG 值，特别关注最大振幅（mA）参数，它是整体血凝块强度的指标。然后评估了人口统计学、生命体征、损伤严重程度和 r-TEG 值。除 r-TEG 值外，还选择了性别和损伤严重程度评分（ISS）作为预测 PE 发生的多变量逻辑回归模型的自变量。
结果
2070 例连续创伤激活患者中进行了 r-TEG 检查。其中 2.5%（53 例）发生了 PE，97.5%（2017 例）未发生 PE。PE 组患者年龄较大（中位数年龄 41 岁 vs. 33 岁，p=0.012），白人比例更高（69% vs. 54%，p=0.036）。PE 组无一例穿透性损伤（0% vs. 25%，无 PE 组，p<0.001）。PE 组入院时 mA 值较高（66 比 63，p=0.050），ISS 较高（中位数 31 比 19，p=0.002）。在校正性别、种族、年龄和 ISS 后，入院时 mA 值升高是 PE 的独立预测因素，mA>65 的优势比为 3.5，mA>72 的优势比为 5.8。
结论
入院时 r-TEG mA 值可识别住院期间发生 PE 的高风险患者。需要进一步研究确定是否应针对这些高危患者使用替代抗凝策略。
证据水平
预后研究，III 级。
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