Clinical Study On Significance Of Thromboelastography In Multiple Trauma Patients

Objective:To investigate the dynamic change of Thromboelastography with multiple trauma and the relationship between Standard coagulopathy tests in multiple trauma patients; the impacts of body temperature on the Thromboelastography, thus to evaluate the value of Thromboelastography in multiple trauma patientsMethods:It's a prospective observation study.45 Patients with multiple trauma admitted to emergency intensive care unit(EICU) from Jan.2010 to June 2010 were enrolled. Thromboelastography (R,K,Angle,MA,CI),PT,APTT,PLT,FIB in patients were detected at 1,3,7d after trauma. It is also collected for indicators of the Thromboelastography, the R,K,angle,MA,CI at three different temperatures 37℃,35℃,33℃. At the day as the injury occurred, we recorded the Injury severity score ISS, Glasgow coma score GCS and Acute physiology and chronic health evaluation II,APACHII.Using statistic software SPSS 17.0 or SigmaStat3.5,the change of Thromboelastography of patients was analyzed. We also compared the change of Thromboelastography between patients with different injury severity and prognosis. The relationships between Thromboelastography and APTT,PT,FIB,PLT were analyzed. We then analyzed the relationship between CI and ISS,GCS,APACHII prognosis respectively.Finally, the impact of temperature on the Thromboelastography were also analyzed.Results:K volume of the Thromboelastography decreased as time passed, while Angle,MA,CI increased Compared to group ISS<25, group ISS≥25 has its K volume decreased slower and the absolute volume is higher at any time point, whereas the Angle,MA,CI, in contrast have absolute volume smaller at early stage and always lower at any time point. The K,R volume of the Non-survivors is obviously higher than the survivors, and higher at any time point, while the Angle,MA,PLT,CI volumes are always lower than at any time point and rises slower.Among multiple trauma patients, the R volume is positively correlated to APTT and PT at the day 1,3 and 7; K volume is negatively correlated to FIB at day 1; Angle is positively correlated to FIB at day1 and 3, MA is positively correlated to PLT at day1 and 7, and MA is positively correlated to FIB at day 1.The R and K volumes of Thromboelastography increased as the temperature declines while the Angle,MA,CI decreased following the decline of temperature. At 37℃Coagulation disorder patient's R and K volume rise sharper as temperature declines. And the R, K absolute volume are higher than normal person at 37℃. The Angle,MA,CI volume on the contrast are at the opposite.Conclusion:1. Multiple trauma patients can develops coagulation disorder at early stage. It has certain principles during its cause and is correlated to the patients'condition and recovery. Thromboelastography is good for evaluation the function of coagulation,2. There is a good correlation between Thromboelastography K,Angle and FIB, and between MA and PLT,FIB. The Thromboelastography can represent the functional status of Fibrinogen and Platelet. This is better than traditional quantitative measure.3. Low temperature has big impact on coagulation. TEG however can work at any temperature, therefore its results can represent the actual Coagulation of the patients at normal body temperature...