| 杨雪林,兰频,潘群婕.血栓弹力图在评估血液毒毒蛇咬伤严重程度中的临床价值[J].浙江中西医结合杂志,2020,30(4): |
| 血栓弹力图在评估血液毒毒蛇咬伤严重程度中的临床价值 |
| Clinical value of thromboelastography in assessing the severity of venomous snakebites with blood poison |
| 投稿时间：2019-10-09 修订日期：2019-12-17 |
| DOI： |
| 中文关键词: 毒蛇咬伤 血液毒 血栓弹力图 严重程度 |
| 英文关键词:Venomous snakebites Blood poison Thromboelastogram Severity |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨血栓弹力图(TEG)在评估血液毒毒蛇咬伤严重程度中的临床价值。方法 选取2016年04月-2019年04月收治在本院急诊科的血液毒毒蛇咬伤患者575例作为研究对象。每一例患者病情严重程度均根据蛇伤严重度评分量表(snakebite severity scale ,SSS)分为轻度组(0-3分)、中度组(4-7分)、重度组(8-20分)。记录每一例患者在应用抗毒蛇血清前凝血功能指标﹝(凝血酶原时间(PT)、纤维蛋白原(FIB)、活化部分凝血活酶时(APTT)、凝血酶时间(TT))﹞,血小板(PLT)；记录TEG指标﹝血凝时间 (R)、血块成型时间 (K)、α角和血块强度 (MA) ﹞。结果 PT、APTT、TT三个指标随毒蛇咬伤后病情严重度越高,指标越高；FIB、PLT随病情严重度越高,指标越低,差异有统计学意义(P<0.05)。TEG中指标R、K值随毒蛇咬伤严重程度越高,指标越高；α角、MA值随病情严重程度越高,指标越低,差异有统计学意义(P<0.05)。采用Pearson 相关分析显示,严重程度与R、K值呈正相关(r值分别为0.763,0.831,P<0.05),与α 角、MA呈负相关(r值分别为-0.677,-0.854,P<0.05)。结论 血液毒毒蛇咬伤后病情严重程度越高,凝血系统异常越明显,TEG可以准确的评估凝血系统状态,能较好的反映血液毒毒蛇咬伤病情严重程度,在临床上有较好的应用价值。 |
| 英文摘要: |
| Objective to investigate the clinical value of thromboelastography(TEG) in evaluating the severity of venomous snakebites with blood poison. Methods A total of 575 patients with venomous snakebites in the emergency department of our hospital from April 2016 to April 2019 were selected as subjects. The severity of each patient was classified into mild group (0-3 points), moderate group (4-7 points), and severe group (8-20) according to the snakebits severity scale (snakebite severity scale,SSS). Record the coagulation function index of each patient in the application of anti-venom serum [(prothrombin time (PT), fibrinogen (FIB), activated partial thromboplastin (APTT), thrombin time (TT))], platelets (PLT); TEG was recorded [blood coagulation time (R), clot formation time (K), alpha angle, and clot strength (MA) ]. Results The higher the severity of snakebites, the higher the PT, APTT and TT; the higher the severity of snakebites, the lower the FIB and PLT, the difference was statistically significant (P<0.05). the higher the severity of snakebites,the higher the R and K, the higher the severity of snakebites, the lower the α angle and MA, the difference was statistically significant (P<0.05). Pearson correlation analysis showed that the severity was positively correlated with R and K (r = 0.763, 0.831, P<0.05), and negatively correlated with α angle and MA (r= -0.677, -0.854, P< 0.05). Conclusion The higher the severity of venomous snakebites with blood poison, the more obvious the abnormality of blood coagulation system. The TEG can accurately assess the coagulation function status, which can better reflect the severity of venomous snakebites with blood poison, has good application value in clinical. |
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