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[1]王希龙,赵玲芳,刘建军,等.血栓弹力图联合凝血指标对早期急性胰腺炎严重程度评估的临床意义[J].医学研究与战创伤救治(原医学研究生学报),2017,19(02):141-144.[doi:10.3969/j.issn.1672-271X.2017.02.007]
　WANG Xi-long,ZHAO Ling-fang,LIU Jian-jun,et al.Clinical significance of TEG combined coagulation testsin evaluating severity of illness in early acute pancreatitis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2017,19(02):141-144.[doi:10.3969/j.issn.1672-271X.2017.02.007]
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血栓弹力图联合凝血指标对早期急性胰腺炎严重程度评估的临床意义()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第19卷
期数:
2017年02期
页码:
141-144
栏目:
出版日期:
2017-03-20

文章信息/Info

Title:
Clinical significance of TEG combined coagulation testsin evaluating severity of illness in early acute pancreatitis
作者:
王希龙; 赵玲芳; 刘建军; 李玉玲; 刘东
730050兰州，兰州军区兰州总医院重症医学科
Author(s):
WANG Xi-long;  ZHAO Ling-fang;  LIU Jian-jun;  LI Yu-ling;  LIU Dong
(Intensive Care Medi-cine, Lanzhou General Hospital of Lanzhou Military Region, PLA, Lanzhou 730050,Gansu,China)
关键词:
早期急性胰腺炎; 血栓弹力图; 凝血指标
Keywords:
Early acute pancreatitis;  Thrombelastograph;  Coagulation test
分类号:
R576
DOI:
10.3969/j.issn.1672-271X.2017.02.007
文献标志码:
A
摘要:
目的 探讨血栓弹力图(thrombelastograph,TEG)联合常规凝血指标在急性胰腺炎(acute pancreatitis, AP）发病早期临床救治中对病情严重程度评估的意义。方法 选取 2015年8月至2016年8月兰州军区兰州总医院发病24 h内收治的急性胰腺炎患者73例为研究对象。依据中华医学会急性胰腺炎诊治指南(2014版)将患者分为轻症组33例(MAP组)、中重症组26例(MSAP组)和重症组14例(SAP组)。完善相关检查，检测常规凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(DD)]，描绘TEG[血凝时间(R)、血块成型时间(K)、α角、血块强度(MA)]。记录24h急性生理与慢性健康评分Ⅱ（acute physiology and shronic health evalu- ationⅡ,APACHEⅡ）及48 h改良Marshall评分，分析监测指标在3组中的变化。结果 中重症组较轻症组PT、APTT、FIB、DD的水平轻度升高(P>0.05)；与中重症组及轻症组比较，重症组PT、APTT、FIB和D-D均显著升高(P<0.05)。3 组R值、K值、α角和MA值比较，差异均有统计学意义(P<0. 05) ; 其中，重症组R值、K值较中重症组和轻症组缩短，重症组α角、MA值大于中重症组和轻症组，差异有统计学意义(P＜0.05)；中重症组R值、K值较轻症组缩短，中重症组α角、MA值大于轻症组，差异有统计学意义(P<0.05)。TEG和APACHⅡ及Marshall评分系统相关性分析：APACHⅡ及Marshall评分和R值及K值呈负相关（r=-0.127，-0.238，-0.459，-0.213）；和α角、MA值呈正相关（r=0.439，0.267，0.379，0.136），差异有统计学意义（P＜0.05）。结论 TEG联合凝血指标可较真实地判断AP患者早期凝血纤溶状态，更准确地预测AP发病早期的严重程度，对临床救治有一定的指导意义。
Abstract:
Objective To investigate the value of thrombelastograph (TEG) combined coagulation test in evaluating severity of illness in early acute pancreatitis (AP).Methods From August 2015 to August 2016, 73 cases of acute pancreatitis with onset less 24 hours were studied. The patients were divided into three groups according to the guidelines for the diagnosis and treatment of AP in Chinese medical association: mild acute pancreatitis (MAP, n=33), moderately severe acute pancreatitis (MSAP, n=26) and severely acute pancreatitis (SAP, n=14). All patients were determined by coagulation tests [activated partial thromboplastin time (APTT), prothrombin (PT), fibrinogen (FIB) and D-Dimmer (D-D)] and TEG (reaction time (R)，kinetics of clot development (K)，α angle and maximum amplitude (MA) simultaneously. While recording acute physiology and shronic health evaluationⅡ(APACHEⅡ) of the patient admitted in 24 hours and Mashall score of the patient admitted in 48 h. The difference and relativity of monitoring index in the three groups were analyzed.Results The value of PT, APTT, FIB and DD in MSAP group were larger than those in MAP group, but there was no significant differences (P >0.05). While the value of PT, APTT, FIB and DD in SAP group were much larger than those in MAP and MSAP groups (P<0.05). Compared with MSAP and MAP groups, the value of R and K in SAP group significantly decreased, and the value of a angle and MA obviously increased (P<0.05). The value of APACHⅡ and Marshall had the negative correlation with R and K (r=-0.127,-0.238, -0.459, -0.213), and had positive correlation with α angle and MA (r=0.439, 0.267, 0.379, 0.136).Conclusion TEG combined conventional coagulation test could comparatively accurately eval-uate the coagulation and fibrinolysis state of patients with AP, and assess the severity in early stage. It′s helpful to clinical care for AP.

参考文献/References:

[1]中华医学会外科学分会胰腺外科学组. 急性胰腺炎诊治指南（2014）[J]. 全科医学临床与教育,2015,13(2):123-124.
[2]Beyazit Y, Sayilir A, Torun S,et al. Mean platelet volume as an indicator of disease severity in patients with acute pancreatitis[J]. Clin Res Hepatol Gastroenterol, 2012,36(2):162-168.
[3]Akbal E, Demirci S, Kocak E,et al. Alterations of platelet function and coagulateon parameters during acute pancreatitis[J]. Blood Coagul Fibrin,2013,24(3):243-246.
[4]Grauvogel J, Grauvogel TD, Gebhard MM, et al. Combined effects ofchronic and acute ethanol on pancreatic injury and microcirculation[J]. Pancreas,2012,41(5):717-723.
[5]李国东，吴德全.急性胰腺炎发病机制研究进展［J］． 肝胆胰外科杂志，2005，17(2): 172-174．
[6]Raraty MG，Connor S，Criddled N，et al． Acute pancreatitis and organ failure: pathophysiology，natural history，and management strategies［J］．Curr Gastroenterol Rep，2004，6(2): 99-103．
[7]刘帅，张婧婧，彭小婉，等.血栓弹力图与常规凝血检测指导临床输血的相关性分析[J].中国医学创新，2016，13（11）：37-40.
[8]马学斌，马骢，杨明，等.TEG血栓弹力图同常规凝血试验的相关性研究[J].国际检验医学杂志，2013，34（24）：3335-3336.
[9]陈冠伊，欧阳锡林，吴靖辉，等.血栓弹力图与常规凝血四项评价临床患者凝血功能的对比研究[J].中国实验血液学杂志，2015，23（2）：546-551.
[10]Radenkovicd V，Bajecd D，Karamarkovic AR． Discussion on applicability of disseminated intravascular coagulation parameters in the assessment of the severity of acute pancreatitis［J］．Pancreas，2006，33(1): 101-107．
[11]Jeger V, Zimmermann H, Exadaktylos AK. Can rapid TEG accelerate the search for coagulopathies in the patient with multiple injuries[J]. J Trauma,2009,66(4):1253-1257.
[12]Gluszek S,Nawacki L,Matykiewicz J,et al. severe vascular complication of pancreatitis[J].Pol Plzeql Chir，2015,87(10):485-490.
[13]杨娜，李维勤，柯路，等.重症胰腺炎并发腹腔大出血凝血功能障碍诊断及处理[J].医学研究生学报，2016，29（4）：416-420.

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备注/Memo

备注/Memo:
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更新日期/Last Update: 2017-03-20