应用活化凝血时间用于严重创伤病人术中检测的可行性研究.docVIP

激活凝血时间用于严重创伤病人术中检测的可行性研究 程明华 （汕头大学医学院第一附属医院麻醉科，广东 汕头 515041） 摘要：目的 探讨激活凝血时间（activated coagulation time，ACT）用于严重创伤病人术中凝血功能监测的可行性。方法 对实施急诊手术的严重创伤病人（ISS＞16分）38例进行前瞻性研究。于麻醉后手术前、手术开始后30min和手术结束时分别测定ACT、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）并测定病人手术前体温和动脉血pH值。结果 严重创伤病人术前ACT值低于正常，但无显著差异（p＞0.05），手术中和手术结束时的ACT值则明显高于正常（p＜0.05），并且与PT、APTT及TT均显著正相关。凝血病创伤病人的ACT值非常显著地高于非凝血病创伤病人（p＜0.001），单次ACT升高达160s以上时，发生凝血病的敏感性为87%，特异性为93%。结论 ACT是总体凝血状况的敏感、快速和经济的检测指标，能为严重创伤手术病人凝血功能紊乱提供可靠诊断依据。 关键词：创伤；凝血；凝血病；激活凝血时间 Feasibility of intraoperative detection of severe trauma patients using the activated coagulation time CHENG Ming-hua, KE Wei-qi，YAO Jian-chun Department of Anesthesiology,First Affiliated Hospital of Medical College of Shantou University, Shantou 515041, Guangdong,,China Abstract: Objective: To study the feasibility of intraoperative detection of severe trauma patients using the activated coagulation time(ACT). Methods: A prospective protocol was used to study 38 victims of severe trauma who underwent immediate intervention(ISS＞16). The ACT, prothrombin time(PT), activated partial thromboplastin time (APTT),thrombin time(TT) were detected at after induction of anesthesia, 30min after the start of operation and end of operation, pH and temperature were determined at the beginning of surgery. Results: The severe trauma patients shawed ACT lower than normal, whereas the ACT values were significantly elevated intraoperatively and at the end of surgery. The ACT measurements of coagulopathic trauma patients were very significantly elevated values when compared with other trauma patients(p＜0.001).The ACT had positive correlation with PT, APTT, TT. Using clinical coagulopathy as the standard, a single elevated ACT above 160s carries a sensitivity of 87% and specificity of 93%. Conclusion: ACT is a sensitive, rapid, and inexpensive indicator of the global coagulation status and may be viewed a new way to detect global coagulation derangements in operative trauma victims. Key words: Inju