血栓弹力描记术作为一种监测充分液体复苏后凝血功能障碍的工具，可以预测感染性休克患者的不良预后。
Thromboelastography as a tool for monitoring blood coagulation dysfunction after adequate fluid resuscitation can predict poor outcomes in patients with septic shock.
机构信息
Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of General Surgery Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
出版信息
J Chin Med Assoc. 2020 Jul;83(7):674-677. doi: 10.1097/JCMA.0000000000000345.
BACKGROUND
Coagulation abnormalities are universal in patients with septic shock and likely play a key role in multiple organ dysfunction syndrome. Early diagnosis and management of sepsis-induced coagulopathy can influence the outcome. Thromboelastography (TEG) can effectively distinguish hypercoagulability and hypocoagulability in patients with septic shock. TEG may be a useful tool to objectively evaluate the degree and risk of sepsis.
METHODS
A total of 76 adult patients with septic shock were enrolled and divided into four groups: patients with hypotension requiring vasopressor and serum lactate level >2 mmol/L (group A), patients with hypotension requiring vasopressor and serum lactate level ≤2 mmol/L (group B), patients with mean arterial pressure ≥65 mmHg and serum lactate level >2 mmol/L (group C), and patients with mean arterial pressure ≥65 mmHg and serum lactate level ≤2 mmol/L (group D) after adequate fluid resuscitation. TEG values were obtained at the emergency room and after 6 hours of adequate fluid resuscitation. Data on fibrinogen (FIB) levels, international normalized ratio (INR), activated partial thromboplastin time (aPTT), blood gas, platelet count, and D-dimers were also collected.
RESULTS
The length of stay in the intensive care unit was 9.11 ± 5.36 days. Mortality rate was 6.58%. The values of reaction time, kinetics time, maximum amplitude, alpha angle, aPTT, INR, serum creatinine, FIB, and sepsis-related organ failure assessment (SOFA) score showed a significant differences. The results of the routine coagulation tests, blood gas volume, platelet count, procalcitonin level, D-dimer level, white blood cell count, creatinine level, disseminated intravascular coagulation score, SOFA score, and TEG values after adequate fluid resuscitation were significantly different between groups A and B, groups A and C, groups A and D, groups B and D, and groups C and D.
CONCLUSION
TEG is helpful in predicting the severity of sepsis and outcome of patients.
背景
凝血异常在感染性休克患者中普遍存在，可能在多器官功能障碍综合征中发挥关键作用。早期诊断和治疗脓毒症诱导的凝血功能障碍可以影响预后。血栓弹力图（TEG）可有效区分感染性休克患者的高凝状态和低凝状态。TEG 可能是客观评估脓毒症严重程度和风险的有用工具。
方法
共纳入 76 例感染性休克成年患者，分为四组：需要升压药治疗且血清乳酸水平＞2mmol/L 的低血压患者（A 组）、需要升压药治疗且血清乳酸水平≤2mmol/L 的低血压患者（B 组）、平均动脉压（MAP）≥65mmHg 且血清乳酸水平＞2mmol/L 的患者（C 组）和 MAP≥65mmHg 且血清乳酸水平≤2mmol/L 的患者（D 组），在充分液体复苏后获得急诊和 6 小时 TEG 值。还收集纤维蛋白原（FIB）水平、国际标准化比值（INR）、活化部分凝血活酶时间（aPTT）、血气、血小板计数和 D-二聚体的数据。
结果
重症监护病房（ICU）住院时间为 9.11±5.36 天，死亡率为 6.58%。反应时间、动力学时间、最大振幅、α 角、aPTT、INR、血清肌酐、FIB 和脓毒症相关器官衰竭评估（SOFA）评分值均有显著差异。充分液体复苏后常规凝血试验、血气量、血小板计数、降钙素原水平、D-二聚体水平、白细胞计数、肌酐水平、弥散性血管内凝血评分、SOFA 评分和 TEG 值在 A、B 组，A、C 组，A、D 组，B、D 组和 C、D 组之间有显著差异。
结论
TEG 有助于预测脓毒症的严重程度和患者的预后。
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