文献导读||创伤患者旋转式血栓弹力测定紊乱背后的凝血病

摘要译文（供参考）

创伤患者旋转式血栓弹力测定紊乱背后的凝血病：

一项前瞻性观察性多中心研究

背景：

粘弹性止血试验，如旋转式血栓弹力测定（ROTEM®），用于指导创伤诱导凝血病的治疗。

我们假设ROTEM紊乱反映了创伤后特定的凝血因子缺乏。

方法：

对六个欧洲创伤中心的一项前瞻性队列研究进行二次分析，研究对象为创伤组完全激活的患者。

稀释性凝血病患者和服用抗凝剂的患者被排除在外。

抽取血液测量ROTEM®、凝血因子水平和纤溶标志物。

ROTEM®定义低凝状态的截止值为：

EXTEM凝血时间（CT）>80s，

EXTEM5分钟后血栓幅度（CA5）<40mm，

EXTEM30分钟溶解度（LI30）<85%，

FITEM5分钟后血栓幅度（CA5）<10mm，

FITEM30分钟溶解度（LI30）<85%。

在此基础上，将患者分为7组，并与对照组进行比较（ROTEM®值在参考范围内）。

主要终点是凝血因子水平和纤溶。

结果：

在1828名患者中，40%的患者患有ROTEM®紊乱达40.0%，最常见的是EXTEM和FIBTEMCA5联合降低，217名患者（11.9%）出现这种情况。

虽然单独的EXTEM CT>80对死亡率没有影响，但所有其他ROTEM®紊乱都与死亡率增加有关。

该组凝血因子水平与ROTEM®正常组相似。

在凝血因子中，纤维蛋白原（最低点为0.78 g/L）和因子V水平（最低点为22.8%）的降低最为明显。

此外，当LI30正常，但EXTEM和FIBETEMCA5降低时，纤维蛋白溶解增加。

结论：

单独凝血时间延长组的凝血因子水平和死亡率与正常ROTEM®患者相似。

其他ROTEM®紊乱与死亡率相关，并反映纤维蛋白原和因子V的消耗。 

30分钟后的溶解正常时，可能出现纤维蛋白溶解增加。

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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