The Study Of Thrombelastography In Trauma Patients With Coagulation Dysfunction

Objectives:(1)Our purpose is to evaluate the diagnostic value of thrombelastography(TEG)for acute traumatic coagulopathy(ATC),to explore the guidance of TEG for transfusion therapy and the predictive effect of TEG for the prognosis in ATC patients.(2)Our objective is to clarify the incidence of fibrinolytic phenotypes in patients with severe trauma,to explore the characteristics of clinical manifestations,transfusion and prognostic indicators in patients with fibrinolytic abnormalities,and to evaluate the identification of TEG for fibrinolytic abnormalities and the treatment guidance of TEG in patients with it.Methods:(1)A retrospective analysis was conducted on all trauma patients received conventional coagulation tests(CCTs)and TEG in the emergency intensive care unit of our hospital from February to December 2018.The definition of ATC is international normalized ratio≥1.3,activated partial thromboplastin time≥35s or platelet count<100×10~9/L.The diagnostic value of TEG for ATC was evaluated by receiver operating characteristic curve and area under the curve(AUC),and the transfusion guidance and the prediction of prognosis of TEG for ATC patients was explored through multiple regression analysis model.(2)We prospectively collected severe trauma patients(injury severity score,ISS>15)who arrived directly at the emergency department within 6 h after injury,while were performed TEG and CCTs before fluid resuscitation.According to the definition of fibrinolysis,all patients were divided into three groups:fibrinolysis shutdown(SD)group(LY30<0.8%),fibrinolysis normal group and hyperfibrinolysis(HF)group(LY30>3%).Correlation analysis between TEG and the clinical manifestations,transfusion and prognostic indicators of patients with fibrinolysis abnormalities was conducted,and the diagnotic effect of TEG on fibrinolytic abnormalities and its guiding effect on the treatment of patients were evaluated.Results:(1)A total of 242 patients(ATC group:82,non-ATC group:160)were included in the study,and the TEG results between the two groups were statistically significant.The largest TEG parameter for AUC of diagnostic ATC was MA(AUC=0.783)and CI(AUC=0.792).After confounding factors were controlled,all TEG parameters were related to the transfusion volume of ATC patients at 24 h after admission and massive transfusion,and the odds ratio(OR)and regression coefficient of R were the largest;K,MA and CI were all related to the total amount of transfusion during hospitalization,and regression coefficient of K were the largest;K,MA and CI were associated with mechanical ventilation time and proportion in ATC patients,while R was associated with mortality.(2)A total of 51 patients with severe patients were included in the study(fibrinolysis shutdown(SD)group:20,normal group:27,hyperfibrinolysis(HF)group:4).The incidence of SD was nearly40%,while HF was less than 10%.The transfusion volume and mechanical ventilation time of patients with HF were significantly higher than those of the other two groups,with the massive transfusion of 75%and the mortality of 50%.The massive transfusion and mortality of patients with SD were both 5%.The rate of hemorrhagic shock in HF group was 100%,while the incidence of deep venous thrombosis and traumatic brain injury in SD group was 45%and 50%,respectively.LY30 is associated with shock and traumatic brain injury in patients with fibrinolytic disorders.Conclusions:(1)MA and CI have the greatest diagnostic value for ATC.TEG can be used to guide the transfusion of ATC patients,R has great guidance for early stage,and K has great guidance for the total transfusion.TEG could predict the mortality,mechanical ventilation time and proportion of ATC patients,and R has the highest value.The use of TEG to detect the coagulation status of patients with trauma is helpful to diagnose ATC and guide the early transfusion treatment of patients.(2)The incidence of SD is high and HF is low in patients with severe trauma.HF patients have large transfusion volume,high mortality and poor prognosis.By contrast,SD patients have a greater survival advantage.HF patients have a very high incidence of shock,and SD patients have a high incidence of deep venous thrombosis and traumatic brain injury.TEG could rapidly diagnose fibrinolytic phenotypes in patients with severe trauma and guide the treatment.