简单的血液气体分析和临床印象可以预测创伤诱导的凝血病吗?
Peter Hilbert-Carius1, Rolf Lefering2, Hermann Wrigge1,3
1Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bergmannstrost BG-Klinikum Halle, Saxonia-Anhalt, Germany.
Hamostaseologie
|January 20, 2025
概括
创伤引起的凝血病 (TIC) 影响了近六分之一的严重受伤患者. 血红蛋白和基过量水平,以及临床症状,可以预测入院时的TIC.
科学领域:
- 创伤学 创伤学 创伤学
- 紧急医疗 紧急医疗
- 临床病理学 临床病理学
背景情况:
- 创伤引起的凝血病 (TIC) 是严重受伤患者的常见并发症,显著增加了发病率和死亡率.
- 早期识别和管理TIC对于改善患者的治疗结果至关重要.
研究的目的:
- 为了研究血液气体参数 (血红蛋白[Hb]和基过量[BE]) 与标准凝血试验 (SCT) 或旋转血栓造血 (ROTEM) 之间的关联.
- 为了确定Hb/BE水平与TIC的发生之间的相关性.
- 评估Hb/BE的预测价值与TIC的临床表现相结合.
主要方法:
- 利用来自DGU创伤登记数据库 (2015-2022) 的成年患者的创伤严重性评分≥9.9的数据.
- 分析了Hb/BE水平与SCT/ROTEM参数之间的相关性.
- 研究了Hb/BE水平与TIC发病率之间的关系,考虑了临床因素.
主要成果:
- 在68996名患者中有17.2%的患者观察到TIC.
- 在Hb/BE水平和SCT之间发现了强烈的相关性.
- 降低Hb和BE水平与TIC频率增加有关;Hb<8 g/dL和BE<-6 mmol/L在60%以上的患者中表示TIC.
- 临床指标如低格拉斯哥昏迷尺度,低血压,显著的液体复苏和多个身体区域的严重损伤与TIC有关.
结论:
- 大约17%的创伤患者在入院时携带TIC.
- 血液气体分析参数 (Hb/BE) 与标准凝血试验有显著的相关性.
- 将Hb/BE水平与临床评估相结合,可以有效预测大多数创伤患者的TIC.
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