文獻導讀||創傷患者旋轉式血栓彈力測定紊亂背後的凝血病

單獨凝血時間延長組的凝血因子水準和死亡率與正常ROTEM®患者相似。其他ROTEM®紊亂與死亡率相關,並反映纖維蛋白原和因子V的消耗。 30分鐘後的溶解正常時,可能出現纖維蛋白溶解增加。

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摘要譯文(供參考)

創傷患者旋轉式血栓彈力測定紊亂背後的凝血病:

一項前瞻性觀察性多中心研究

背景:

粘彈性止血試驗,如旋轉式血栓彈力測定(ROTEM®),用於指導創傷誘導凝血病的治療。

我們假設ROTEM紊亂反映了創傷後特定的凝血因子缺乏。

方法:

對六個歐洲創傷中心的一項前瞻性隊列研究進行二次分析,研究對象為創傷組完全激活的患者。

稀釋性凝血病患者和服用抗凝劑的患者被排除在外。

抽取血液測量ROTEM®、凝血因子水準和纖溶標誌物。

ROTEM®定義低凝狀態的截止值為:

EXTEM凝血時間(CT)>80s,

EXTEM5分鐘後血栓幅度(CA5)<40mm,

EXTEM30分鐘溶解度(LI30)<85%,

FITEM5分鐘後血栓幅度(CA5)<10mm,

FITEM30分鐘溶解度(LI30)<85%。

在此基礎上,將患者分為7組,並與對照組進行比較(ROTEM®值在參考範圍內)。

主要終點是凝血因子水準和纖溶。

結果:

在1828名患者中,40%的患者患有ROTEM®紊亂達40.0%,最常見的是EXTEM和FIBTEMCA5聯合降低,217名患者(11.9%)出現這種情況。

雖然單獨的EXTEM CT>80對死亡率沒有影響,但所有其他ROTEM®紊亂都與死亡率增加有關。

該組凝血因子水準與ROTEM®正常組相似。

在凝血因子中,纖維蛋白原(最低點為0.78 g/L)和因子V水準(最低點為22.8%)的降低最為明顯。

此外,當LI30正常,但EXTEM和FIBETEMCA5降低時,纖維蛋白溶解增加。

結論:

單獨凝血時間延長組的凝血因子水準和死亡率與正常ROTEM®患者相似。

其他ROTEM®紊亂與死亡率相關,並反映纖維蛋白原和因子V的消耗。 

30分鐘後的溶解正常時,可能出現纖維蛋白溶解增加。

原文摘要

The coagulopathy underlying rotationalthromboelastometry derangements in trauma patients: a prospective observationalmulticenter study

Background:

Viscoelastichemostatic assays such as rotational thromboelastometry (ROTEM®) are used toguide treatment of trauma induced coagulopathy. We hypothesized that ROTEMderangements reflect specific coagulation factor deficiencies after trauma.

Methods:

Secondaryanalysis of a prospective cohort study in six European trauma centers inpatients presenting with full trauma team activation. Patients with dilutionalcoagulopathy and patients on anticoagulants were excluded. Blood was drawn onarrival for measurement of ROTEM®, coagulation factor levels and markers offibrinolysis. ROTEM® cut-off values to define hypocoagulability were: EXTEMclotting time (CT) >80s, EXTEM clot amplitude after 5 minutes (CA5)<40mm, EXTEM lysis at 30 minutes (Li30) <85%, FIBTEM clot amplitude after5 minutes (CA5) <10mm and FIBTEM lysis at 30 minutes (Li30) <85%. Basedon these, patients were divided into 7 deranged ROTEM® profiles and compared tothe reference group (ROTEM® values within reference range). The primaryendpoint was coagulation factors levels and fibrinolysis.

Results:

Of1828 patients, 40% had ROTEM® derangements 40.0%, most often consisting of acombined decrease in EXTEM and FIBTEM CA5, that was present in 217 (11.9%)patients. While an isolated EXTEM CT>80s had no impact on mortality, allother ROTEM® derangements were associated with increased mortality. Also,coagulation factor levels in this group were similar to patients with a normalROTEM®. Of coagulation factors, decrease was most apparent for fibrinogen (witha nadir of 0.78 g/L) and for factor V levels (with a nadir of 22.8%). Inaddition, increased fibrinolysis can be present when LI30 is normal but EXTEMand FIBTEM CA5 is decreased.

Conclusion:

Coagulationfactor levels and mortality in the group with an isolated clotting timeprolongation is similar to patients with a normal ROTEM ®. Other ROTEM ®derangements are associated with mortality and reflect a depletion offibrinogen and factor V. Increased fibrinolysis can be present when lysis after30 minutes is normal.

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