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传统的凝血试验和ROTEM在识别创伤诱导的大型出血协议激活的凝血病时的比较

Sakara Hutspardol^1,2, Tyrone Borja², Jenna Kroeker^3,4

¹Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.

Transfusion medicine (Oxford, England)

|January 26, 2025

概括

旋转性血栓形成显微镜 (ROTEM) 对于识别创伤诱导的凝血病 (TIC) 比传统的凝血测试 (CCT) 更敏感. 然而,异常的CCT,而不是ROTEM,与创伤患者的较高死亡率有关.

科学领域:

创伤护理和重症病的治疗.
凝血诊断仪器凝血诊断仪器
紧急医疗紧急医疗

背景情况:

创伤引起的凝血病 (TIC) 是一种危及生命的疾病,需要及早检测.
旋转性血小板造影仪 (ROTEM) 越来越多地用于指导创伤患者的输血.
了解ROTEM与TIC常规凝血试验 (CCT) 的诊断性能至关重要.

研究的目的:

评估与TIC相关的患者结局,根据初始ROTEM和CCT结果定义.
为了比较ROTEM和CCT在大量出血协议 (MHP) 激活期间识别TIC的诊断灵敏度.
评估TIC定义与创伤患者28天死亡率之间的相关性.

主要方法:

对需要MHP激活的成年创伤患者进行回顾性观察性研究.
通过特定的ROTEM参数 (EXTEM A10,EXTEM CT,EXTEM ML30,FIBTEM A10) 和CCT参数 (INR,PTT,血小板,Clauss Fibrinogen) 定义的TIC.
用于建模28天死亡率的修改Poisson回归.

主要成果:

32%的患者表现出异常的ROTEM与正常的CCT.
由CCT定义的TIC显示与24小时和28天死亡率的增加有显著的关联.
尽管血液产品输血需求更高,但ROTEM定义的TIC与死亡率的增加没有显著关联.

结论:

与CCT相比,ROTEM在识别ICT方面表现出更高的敏感性.
异常的CCT,而不是异常的ROTEM,与较高的死亡率有关.
需要进一步的前性研究来充分评估ROTEM在创伤护理中的临床影响.

关键词:

罗特姆公司 (ROTEM)传统的凝血试验.纤维素原体是有纤维的发生大规模出血.输血是输血的方法之一.

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