运用血栓弹力图管理创伤性凝血病
Management of Trauma-Induced Coagulopathy with Thrombelastography.
作者信息
Gonzalez Eduardo, Moore Ernest E, Moore Hunter B
机构信息
Department of Surgery, University of Colorado, 12700 East 19th Avenue, Denver, CO 80045, USA.
Department of Surgery, University of Colorado, 12700 East 19th Avenue, Denver, CO 80045, USA; Department of Surgery, Denver Health Medical Center, 77 Bannock Street, Denver, CO 80204, USA; Editorial office, Journal of Trauma and Acute Care Surgery, 655 Broadway, Suite 365, Denver, CO 80203, USA.
出版信息
Crit Care Clin. 2017 Jan;33(1):119-134. doi: 10.1016/j.ccc.2016.09.002.
Abstract
Viscoelastic assays, such as thrombelastography (TEG) and rotational thrombelastometry (ROTEM), have emerged as point-of-care tools that can guide the hemostatic resuscitation of bleeding injured patients. This article describes the role of TEG in contemporary trauma care by explaining this assay's methodology, clinical applications, and result interpretation through description of supporting studies to provide the reader with an evidence-based user's guide. Although TEG and ROTEM are assays based on the same viscoelastic principle, this article is focused on data supporting the use of TEG in trauma, because it is available in trauma centers in North America; ROTEM is mostly available in Europe.
摘要
黏弹性检测，如血栓弹力图（TEG）和旋转血栓弹力测定法（ROTEM），已成为可指导出血受伤患者进行止血复苏的即时检测工具。本文通过解释该检测方法、临床应用以及通过对支持性研究的描述进行结果解读，来描述TEG在当代创伤护理中的作用，为读者提供一份基于证据的用户指南。尽管TEG和ROTEM是基于相同黏弹性原理的检测方法，但本文重点关注支持TEG在创伤中应用的数据，因为它在北美的创伤中心可用；ROTEM大多在欧洲可用。
相似文献
1
Management of Trauma-Induced Coagulopathy with Thrombelastography.
Crit Care Clin. 2017 Jan;33(1):119-134. doi: 10.1016/j.ccc.2016.09.002.
2
Data-driven Development of ROTEM and TEG Algorithms for the Management of Trauma Hemorrhage: A Prospective Observational Multicenter Study.
Ann Surg. 2019 Dec;270(6):1178-1185. doi: 10.1097/SLA.0000000000002825.
3
Viscoelastic Studies: Effective Tools for Trauma and Surgical Resuscitation Efforts.
AORN J. 2017 Apr;105(4):370-383. doi: 10.1016/j.aorn.2017.01.013.
4
A systematic review on the rotational thrombelastometry (ROTEM®) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients.
Scand J Trauma Resusc Emerg Med. 2016 Oct 3;24(1):114. doi: 10.1186/s13049-016-0308-2.
5
Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays.
Ann Surg. 2016 Jun;263(6):1051-9. doi: 10.1097/SLA.0000000000001608.
6
Thrombelastography (TEG®): practical considerations on its clinical use in trauma resuscitation.
Scand J Trauma Resusc Emerg Med. 2013 Apr 16;21:29. doi: 10.1186/1757-7241-21-29.
7
Thrombelastography early amplitudes in bleeding and coagulopathic trauma patients: Results from a multicenter study.
J Trauma Acute Care Surg. 2018 Feb;84(2):334-341. doi: 10.1097/TA.0000000000001735.
8
Management of major trauma haemorrhage: treatment priorities and controversies.
Br J Haematol. 2011 Dec;155(5):537-48. doi: 10.1111/j.1365-2141.2011.08885.x. Epub 2011 Oct 21.
9
Viscoelastic guidance of resuscitation.
Curr Opin Anaesthesiol. 2014 Apr;27(2):212-8. doi: 10.1097/ACO.0000000000000051.
10
Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma induced coagulopathy in adult trauma patients with bleeding.
Cochrane Database Syst Rev. 2015 Feb 16;2015(2):CD010438. doi: 10.1002/14651858.CD010438.pub2.
引用本文的文献
1
Perioperative Blood Management on a Successful Surgical Operation of a Patient With Congenital Coagulation Factor V Deficiency.
Clin Case Rep. 2025 Sep 9;13(9):e70888. doi: 10.1002/ccr3.70888. eCollection 2025 Sep.
2
Rapid Thromboelastography Identifies Coagulopathy and Predicts Poor Outcomes in Severe Traumatic Brain Injury.
Cureus. 2025 Jul 11;17(7):e87710. doi: 10.7759/cureus.87710. eCollection 2025 Jul.
3
Viscoelastic Hemostatic Assays are Associated With Mortality and Blood Transfusion in a Multicenter Cohort.
J Am Coll Emerg Physicians Open. 2025 Jan 24;6(2):100042. doi: 10.1016/j.acepjo.2024.100042. eCollection 2025 Apr.
4
ROTEM's utility in guiding resuscitation of traumatic lower extremity fracture patients.
Arch Orthop Trauma Surg. 2025 Feb 25;145(1):170. doi: 10.1007/s00402-025-05773-4.
5
Assessment of Bleeding in Acute Febrile Illness with Thrombocytopenia Using Thromboelastography and Conventional Coagulation Parameters in the Emergency Department (ABATE): A Prospective Cohort Study.
Am J Trop Med Hyg. 2025 Feb 11;112(5):1140-1145. doi: 10.4269/ajtmh.24-0560. Print 2025 May 7.
6
Viscoelastic Study of Hemostasis Disorders Associated with Envenoming in North Benin Using a Quantra Analyzer.
Toxins (Basel). 2024 Dec 24;17(1):3. doi: 10.3390/toxins17010003.
7
Coagulation Factor XIII - Last to think about?
Blood Transfus. 2025 Jan;23(1):70-74. doi: 10.2450/BloodTransfus.902. Epub 2024 Dec 3.
8
The impact of different treatments on thromboelastography and other conventional parameters in patients with colorectal cancer.
Discov Oncol. 2024 Dec 4;15(1):748. doi: 10.1007/s12672-024-01311-7.
9
The role of factor XIII in patient blood management.
Blood Coagul Fibrinolysis. 2024 Oct 1;35(7):325-333. doi: 10.1097/MBC.0000000000001326. Epub 2024 Sep 30.
10
Management of Bleeding Diathesis in Elective and Orthopaedic Trauma: A Review.
J Am Acad Orthop Surg. 2025 Feb 15;33(4):168-177. doi: 10.5435/JAAOS-D-23-01109. Epub 2024 Oct 1.
本文引用的文献
1
Rapid thrombelastography thresholds for goal-directed resuscitation of patients at risk for massive transfusion.
J Trauma Acute Care Surg. 2017 Jan;82(1):114-119. doi: 10.1097/TA.0000000000001270.
2
Fatality and Severity of Firearm Injuries in a Denver Trauma Center, 2000-2013.
JAMA. 2016 Jun 14;315(22):2465-7. doi: 10.1001/jama.2016.5978.
3
Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays.
Ann Surg. 2016 Jun;263(6):1051-9. doi: 10.1097/SLA.0000000000001608.
4
Use of fibrinogen concentrate in bleeding patients.
Anaesthesia. 2015 Nov;70(11):1323-4. doi: 10.1111/anae.13236.
5
Plasma is the physiologic buffer of tissue plasminogen activator-mediated fibrinolysis: rationale for plasma-first resuscitation after life-threatening hemorrhage.
J Am Coll Surg. 2015 May;220(5):872-9. doi: 10.1016/j.jamcollsurg.2015.01.026. Epub 2015 Mar 31.
6
Detailed description of all deaths in both the shock and traumatic brain injury hypertonic saline trials of the Resuscitation Outcomes Consortium.
Ann Surg. 2015 Mar;261(3):586-90. doi: 10.1097/SLA.0000000000000837.
7
Hyperfibrinolysis, physiologic fibrinolysis, and fibrinolysis shutdown: the spectrum of postinjury fibrinolysis and relevance to antifibrinolytic therapy.
J Trauma Acute Care Surg. 2014 Dec;77(6):811-7; discussion 817. doi: 10.1097/TA.0000000000000341.
8
A principal component analysis of postinjury viscoelastic assays: clotting factor depletion versus fibrinolysis.
Surgery. 2014 Sep;156(3):570-7. doi: 10.1016/j.surg.2014.04.030. Epub 2014 Jun 21.
9
Activated clotting time of thrombelastography (T-ACT) predicts early postinjury blood component transfusion beyond plasma.
Surgery. 2014 Sep;156(3):564-9. doi: 10.1016/j.surg.2014.04.017. Epub 2014 Jun 2.
10
Intra- and inter-centre standardisation of thromboelastography (TEG®).
Anaesthesia. 2014 Aug;69(8):883-90. doi: 10.1111/anae.12748. Epub 2014 May 20.
Zotero 插件