The impact of thromboelastography on patients with penetrating abdominal trauma requiring intensive care.

IF 0.4 4区 医学 Q4 SURGERY
M Hannington, D Nel, M Miller, A Nicol, P Navsaria
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引用次数: 0

Abstract

Background: Trauma-induced coagulopathy (TIC) is a complex multifaceted process which contributes to higher mortality rates in severely injured trauma patients. Thromboelastography (TEG) is effective in detecting TIC which assists in instituting goal-directed therapy as part of damage control resuscitation.

Methods: This retrospective study included all adult patients over a 36-month period with penetrating abdominal trauma who required a laparotomy, blood products and admission for critical care. Analysis included demographics, admission data, 24-hour interventions, TEG parameters and 30-day outcomes.

Results: Eighty-four patients with a median age of 28 years were included. The majority (93%; 78/84) suffered from a gunshot injury, with 75% (63/84) receiving a damage control laparotomy. Forty-eight patients (57%) had a TEG. Injury severity score and total fluid and blood product administered in the first 24 hours were all significantly higher in patients who had a TEG (p < 0.05). TEG profiles were: 42% (20/48) normal, 42% (20/48) hypocoagulable, 12% (6/48) hypercoagulable and 4% (2/48) mixed parameters. Fibrinolysis profiles were: 48% (23/48) normal, 44% (21/48) fibrinolysis shutdown and 8% (4/48) hyperfibrinolysis. Mortality rate was 5% (4/84) at 24 hours and 26% (22/84) at 30 days, with no difference between the two groups. High-grade complication rates, days on a ventilator and intensive care unit length of stay were all significantly higher in patients who did not have a TEG.

Conclusion: TIC is common in severely injured penetrating trauma patients. The usage of a thromboelastogram did not impact on 24-hour or 30-day mortality but did result in a decreased intensive care stay and a decreased high-grade complication rate.

血栓弹性成像对需要重症监护的腹部穿透性创伤患者的影响。
背景:创伤性凝血功能障碍(TIC)是一个复杂的多层面过程,是造成严重创伤患者较高死亡率的原因之一。血栓弹性成像(TEG)是有效的检测TIC,这有助于建立目标导向的治疗作为损伤控制复苏的一部分。方法:这项回顾性研究纳入了所有36个月以上的腹部穿透性创伤的成年患者,这些患者需要剖腹手术、采血并入院接受重症监护。分析包括人口统计学、入院数据、24小时干预、TEG参数和30天结局。结果:84例患者入组,中位年龄28岁。大多数人(93%;78/84)遭受枪伤,其中75%(63/84)接受了损伤控制剖腹手术。48例患者(57%)有TEG。TEG患者的损伤严重程度评分和前24小时给予的总液体和血液制品均显著高于TEG患者(p < 0.05)。TEG分布:正常42%(20/48),低凝42%(20/48),高凝12%(6/48),混合参数4%(2/48)。纤溶情况为:48%(23/48)正常,44%(21/48)纤溶停止,8%(4/48)纤溶过度。24 h死亡率为5% (4/84),30 d死亡率为26%(22/84),两组间无差异。在没有TEG的患者中,高度并发症发生率、使用呼吸机的天数和重症监护病房的住院时间都明显更高。结论:TIC在严重穿透伤患者中较为常见。血栓弹性图的使用对24小时或30天的死亡率没有影响,但确实减少了重症监护时间和降低了高级并发症的发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.80
自引率
20.00%
发文量
43
审稿时长
>12 weeks
期刊介绍: The South African Journal of Surgery (SAJS) is a quarterly, general surgical journal. It carries research articles and letters, editorials, clinical practice and other surgical articles and personal opinion, South African health-related news, obituaries and general correspondence.
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