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腹腔积血犬的旋转血栓弹力图(ROTEM)参数及其与临床和实验室指标的关联

Rotational thromboelastometry (ROTEM) parameters in dogs with haemoperitoneum and their associations with clinical and laboratory signs.

作者信息

Martin A, Kutter A, Sigrist N

机构信息

Division of Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty, University of Zurich.

Section of Anaesthesiology, Department for Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich.

出版信息

Schweiz Arch Tierheilkd. 2020 Mar;162(3):153-161. doi: 10.17236/sat00249.

Abstract

Rotational thromboelastometry (ROTEM) is a viscoelastic coagulation test that allows the evaluation of haemostasis from clot formation to clot dissolution. The aim of this retrospective study was to describe the changes in haemostasis using ROTEM parameters in dogs presenting with spontaneous or traumatic haemoperitoneum and to evaluate any associations between clinical and laboratory parameters at presentation with the ROTEM. We hypothesized that the dogs would show signs of hypocoagulability and hyperfibrinolysis and that these changes would correlate with the degree of hypoperfusion. Clinical records were searched for a period of 5 years for dogs presenting with a haemoperitoneum und for whom a -ROTEM analysis at presentation was carried out. Forty dogs were identified, and various clinical and laboratory parameter (heart rate, blood pressure, blood glucose, lactate, serum albumin concentration, PCV (venous and abdominal), ionized calcium, pH and base excess) were retrieved. The following ROTEM parameters were analysed: extrinsic clotting time (ExTEM CT), clot formation time (ExTEM CFT), clot firmness (ExTEM MCF) and maximum lysis (ExTEM ML), as well as fibrinogen (FibTEM) CT and MCF. Compared to institutional reference intervals, dogs with haemoabdomen showed prolongation of ExTEM and FibTEM CT, ExTEM CFT and 50% were hypocoagulable and 62% thrombocytopenic. No hyperfibrinolysis could be detected. Multiple linear regression models showed an association between decreased base excess, trauma and ROTEM signs for hypocoagulability. Furthermore, age was associated with a stronger fibrin clot. In conclusion, 50% of the dogs presented hypocoagulable and changes in ROTEM parameters are similar to those seen with consumption coagulopathy. Base excess and trauma were associated with hypocoagulability, while increasing age was associated with a stronger fibrin clot.

摘要

旋转血栓弹力图(ROTEM)是一种粘弹性凝血试验,可用于评估从凝血块形成到溶解过程中的止血情况。本回顾性研究的目的是描述使用ROTEM参数对自发性或创伤性血腹症犬止血情况的变化,并评估就诊时临床和实验室参数与ROTEM之间的任何关联。我们假设犬会出现低凝和高纤溶迹象,且这些变化与低灌注程度相关。对5年期间出现血腹症且就诊时进行了ROTEM分析的犬的临床记录进行检索。共识别出40只犬,并获取了各种临床和实验室参数(心率、血压、血糖、乳酸、血清白蛋白浓度、静脉和腹腔血细胞比容、离子钙、pH值和碱剩余)。分析了以下ROTEM参数:外源性凝血时间(ExTEM CT)、凝血形成时间(ExTEM CFT)、凝血硬度(ExTEM MCF)和最大溶解率(ExTEM ML),以及纤维蛋白原(FibTEM)CT和MCF。与机构参考区间相比,血腹症犬的ExTEM和FibTEM CT、ExTEM CFT延长,50%的犬存在低凝,62%的犬血小板减少。未检测到高纤溶现象。多元线性回归模型显示碱剩余降低、创伤与低凝的ROTEM迹象之间存在关联。此外,年龄与更强的纤维蛋白凝块有关。总之,50%的犬表现为低凝,ROTEM参数变化与消耗性凝血病相似。碱剩余和创伤与低凝有关,而年龄增加与更强的纤维蛋白凝块有关。

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