出血和凝血病创伤患者血栓弹力描记早期幅度：多中心研究结果。
Thrombelastography early amplitudes in bleeding and coagulopathic trauma patients: Results from a multicenter study.
机构信息
From the Section for Transfusion Medicine (T.H.L., M.A.S.M., J.S., S.R.O., P.I.J.), Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Traumatology (T.G., P.A.N.), Oslo University Hospital, Ulleval, Oslo, Norway; University of Oslo (P.A.N.), Oslo, Norway; Department of Anesthesiology, Centre of Head and Orthopedics (J.S.), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Surgery, University of Texas Health Medical School(P.I.J.), Houston, TX; Center for Systems Biology, University of Iceland(P.I.J.), Reykjavik, Iceland.
出版信息
J Trauma Acute Care Surg. 2018 Feb;84(2):334-341. doi: 10.1097/TA.0000000000001735.
BACKGROUND
Early amplitudes in the viscoelastic hemostatic assays, thrombelastography (TEG) and rotation thromboelastometry (ROTEM), provide fast results, which is critical in the resuscitation of bleeding patients. This study investigated associations between TEG early amplitudes and standard TEG variables in a large multicenter cohort of moderately to severely injured trauma patients admitted at three North European Level I Trauma Centers.
METHODS
Prospective observational study of 404 trauma patients with clinical suspicion of severe injury from London, UK, Copenhagen, Denmark and Oslo, Norway. Biochemistry and clinical data including outcome and TEG parameters were recorded upon arrival. Kaolin TEG, Rapid TEG, and TEG functional fibrinogen curves were extracted, and early amplitudes A5 and A10 (amplitude at 5 and 10 minutes) were registered. Patients were stratified according to international normalized ratio of 1.2 or less or greater than 1.2, as well as transfusion requirements (nontransfused, 1-9 red blood cell units and ≥10 red blood cell units in 12 hours).
RESULTS
In total, 404 patients were included, median Injury Severity Score was 13. There were strong positive correlations between A5/A10 and maximum amplitude in all investigated assays. All TEG values except rTEG maximum amplitude and kTEG maximum amplitude correlated significantly with mortality in transfused patients. Time from initiation of assay to A5 and A10 were lowest for rapid TEG and TEG functional fibrinogen compared with kaolin TEG. Rapid TEG A5 reduced time to result with greater than 50% compared with rapid TEG maximum amplitude.
CONCLUSION
We found strong associations between TEG early amplitudes A5/A10 and maximum amplitude in rapid TEG, kaolin TEG, and TEG functional fibrinogen across trauma patients with coagulopathy and massive transfusion requirements. Introducing the use of early amplitudes can reduce time to diagnosis of coagulopathy and may be used in TEG monitoring of trauma patient. Further randomized controlled trials evaluating the role of TEG in guiding hemostatic resuscitation are warranted.
LEVEL OF EVIDENCE
Prognostic study, level III.
背景
在止血弹性测定法（血栓弹力描记法 [TEG] 和旋转血栓弹性描记法 [ROTEM]）中，早期振幅提供了快速的结果，这在出血患者的复苏中至关重要。本研究在三个北欧一级创伤中心收治的中度至重度创伤患者的大型多中心队列中，研究了 TEG 早期振幅与标准 TEG 变量之间的相关性。
方法
对来自英国伦敦、丹麦哥本哈根和挪威奥斯陆的 404 例疑似严重受伤的创伤患者进行前瞻性观察性研究。记录入院时的生物化学和临床数据，包括结局和 TEG 参数。提取高岭土 TEG、快速 TEG 和 TEG 功能纤维蛋白原曲线，并记录早期振幅 A5 和 A10（5 分钟和 10 分钟时的振幅）。根据国际标准化比值（INR）为 1.2 或以下或大于 1.2，以及输血需求（未输血、1-9 个红细胞单位和 12 小时内≥10 个红细胞单位）对患者进行分层。
结果
共纳入 404 例患者，损伤严重程度评分中位数为 13。在所有研究的检测中，A5/A10 与最大振幅之间存在强正相关。除 rTEG 最大振幅和 kTEG 最大振幅外，所有 TEG 值均与输血患者的死亡率显著相关。与高岭土 TEG 相比，快速 TEG 和 TEG 功能纤维蛋白原的检测从开始到 A5 和 A10 的时间最短。与快速 TEG 最大振幅相比，快速 TEG A5 将获得结果的时间减少了 50%以上。
结论
我们发现，在凝血功能障碍和大量输血需求的创伤患者中，快速 TEG、高岭土 TEG 和 TEG 功能纤维蛋白原的早期振幅 A5/A10 与最大振幅之间存在强烈相关性。引入早期振幅可以缩短凝血功能障碍的诊断时间，并可用于创伤患者的 TEG 监测。进一步的随机对照试验评估 TEG 在指导止血复苏中的作用是必要的。
证据水平
预后研究，III 级。
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