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【Objective】 To explore the clinical value of thromboelas-tography, coagulation four items and platelet count in guiding platelet transfusion in critically ill patients. 【Methods】 A total of 188 critically ill patients in Intensive Care Unit of our hospital from January 2020 to January 2022 were selected as subjects, and were divided into study group(n=89) and the control(n=99) according to the presence of bleeding symptoms. T-test was used for comparative analysis between the two groups. Spearman was used to analyze the correlation between TEG, coagulation four items and platelet count, and binary Logistic regression analysis was used to predict the influential factors of bleeding in critically ill patients, ROC curve was used to analyze the guiding value of the above-mentioned indexes for platelet transfusion. 【Results】 1) K and PT values in the study group, above the normal range, were significantly higher than those in the control, while the Angle value, MA value, CI value, FIB value and platelet count were significantly lower than those of the control, among which MA value, CI value and platelet count were below the normal range. 2) TEG, coagulation four items and platelet count were correlated. MA and CI values were positively correlated with platelet count, instead, R and K values were negatively correlated. R value was positively correlated with PT and APTT, CI value, on the contrary, was negatively correlated, K value was positively correlated with PT, while Angle value and MA value were negatively correlated. 3) Binary Logistic regression analysis showed that decreased MA value and decreased platelet count were independent risk factors for predicting bleeding in critically ill patients(P<0.05). 4) ROC curve analysis showed that the areas under ROC curve corresponding to Angle value, MA value, CI value, FIB value and platelet count were 0.866, 0.932, 0.9, 0.838 and 0.987(P<0.05). The sensitivity was highest in platelet count and lowest in FIB. The specificity was highest in MA and lowest in Angle. Compared with the single index, the area under the curve of the combined index(K value, MA value, CI value, PT value and platelet count) was 0.995(P<0.05), Yoden index 0.944, sensitivity 100%, specificity 93.3%, all higher than the individual index. 【Conclusion】 Thromboelas-tography combined with coagulation four items and platelet count can be used to accurately predict the critically ill patients with bleeding risk. To guide clinical platelets transfusion, the combined use of indexes, including K value, MA, CI value, PT and platelet count, is superior to separate use of them as the former showed better sensitivity and specificity, demonstrating a good clinical value.
ABSTRACT
【Objective】 To explore the prognosis of critically ill patients with coagulation dysfunction using thrombelastogram(TEG) and coagulation four items combined with APACHEⅡ score. 【Methods】 From March 2017 to March 2020, 287 critically ill patients with coagulation dysfunction in our hospital were selected as the study group, and 303 patients with normal coagulation function during the same period were set as the control. The study group was divided into low-risk group(group A), intermediate-risk group(group B) and high-risk group (group C) based on the APACHEⅡ score, and into survival group and death group according to the prognosis. The difference of TEG, coagulation four items, and APACHEⅡ scores between the two groups were analyzed. The correlation and difference between TEG, coagulation four items and APACHE II score in the study group were analyzed. The ROC curve was drawn to analyze the prognostic predictive value of research indicators. 【Results】 Blood coagulation function related indicators in the study group fluctuated significantly: in comparison to the control, the CI value, MA value, and α angle were smaller, while the K time and R time were longer; among the coagulation four items, PT, APTT and TT were higher; Fg level was lower, and the APACHE Ⅱ score was higher(P0.05). There were significant differences between the TEG and coagulation function related index levels in patients with different prognosis. Compared with the survivals, the CI value, MA value and α angle of the dead group were smaller, while the K time and R time were longer; and among the coagulation four items, PT, APTT, and TT were higher, the Fg level was lower, and the APACHEⅡ score was higher (PP4\\P5>APACHE Ⅱ score>P1>P2. 【Conclusion】 TEG, coagulation four items, and APACHE Ⅱ score can be used to assess the severity of patients with severe coagulation dysfunction. and the combined application of the 3 indicators are of high value in predicting the prognosis of such patients, and can provide reference for clinical formulation or adjustment of intervention programs to correct coagulation dysfunction.
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Objective To observe and analyze the four changes of plasma D- dimer and coagulation in pregnant women at different stages of pregnancy, and to explore the value of the test. Methods The subjects of this study were 120 pregnant women who underwent routine physical examination in our hospital, according to different stages of pregnancy (early pregnancy, middle pregnancy, late pregnancy, and before delivery) Four D- dimer and four blood coagulation tests were performed in pregnant women, and the results were observed and compared. Results During the pregnancy, D- dimer has increase trend (P<0.05); early in pregnancy, pregnancy and late pregnancy, PT has shortened(P<0.05); pregnancy, APTT has shortened (P<0.05), at the end of pregnancy and parturient period, showing a significant shortening (P<0.05); phenomenon in early pregnancy to mid pregnancy stage, FIB increased significantly (P<0.05), and at the end of pregnancy to perinatal period, with a sharp increase (P<0.05). Conclusion It is of great significance to perform dynamic monitoring of of plasma D- dimer and coagulation four indices in pregnant women during pregnancy.
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Objective To investigate the specificity and sensitivity of coagulation four and D-dimer in early diagnosis of hypertension in pregnancy and its clinical significance. Methods 120 cases of pregnant women with pregnancy induced hypertension in department of Laboratory, the third affiliated hospital of Jinzhou medical university from February to December in 2016, were enrolled in the observation group. According to their different conditions of disease, including 50 cases of pregnancy-induced hypertension, 40 cases of mild preeclampsia, 30 cases of severe preeclampsia. 30 cases of normal pregnant women were selected as the control group. The coagulation and the D-dimer of the pregnancy-induced hypertension group and the control group were detected. Results The D-dimer (D-D) and fibrinogen (FIB) in the observation group were higher than those in the control group, the prothrombin time (PT), the activated partial thromboplastin time (APTT) and the thrombin time (TT) were shorter than the control group, the difference was statistically significant (P<0.05). The levels of PT, APTT and TT in severe preeclampsia group were lower than those in the pregnancy-induced hypertension group, D-D and FIB were higher than those in pregnancy-induced hypertension group, and severe preeclampsia was lower than that in mild preeclampsia group. D-D, FIB were higher than mild preeclampsia group, APTT in the mild preeclampsia group lower than the pregnancy-induced hypertension group, DD, FIB higher than the pregnancy-induced hypertension group, the difference was statistically significant (P<0.05). Specificity and sensitivity of coagulation and D-dimer were higher than coagulation four, D-D dimer detection. Conclusion Coagulation and D-dimer are great value in the early diagnosis of hypertension and the severity of pregnancy. Joint detection could improve the specificity and sensitivity of diagnosis.
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Objective To investigate the specificity and sensitivity of coagulation four and D-dimer in early diagnosis of hypertension in pregnancy and its clinical significance. Methods 120 cases of pregnant women with pregnancy induced hypertension in department of Laboratory, the third affiliated hospital of Jinzhou medical university from February to December in 2016, were enrolled in the observation group. According to their different conditions of disease, including 50 cases of pregnancy-induced hypertension, 40 cases of mild preeclampsia, 30 cases of severe preeclampsia. 30 cases of normal pregnant women were selected as the control group. The coagulation and the D-dimer of the pregnancy-induced hypertension group and the control group were detected. Results The D-dimer (D-D) and fibrinogen (FIB) in the observation group were higher than those in the control group, the prothrombin time (PT), the activated partial thromboplastin time (APTT) and the thrombin time (TT) were shorter than the control group, the difference was statistically significant (P<0.05). The levels of PT, APTT and TT in severe preeclampsia group were lower than those in the pregnancy-induced hypertension group, D-D and FIB were higher than those in pregnancy-induced hypertension group, and severe preeclampsia was lower than that in mild preeclampsia group. D-D, FIB were higher than mild preeclampsia group, APTT in the mild preeclampsia group lower than the pregnancy-induced hypertension group, DD, FIB higher than the pregnancy-induced hypertension group, the difference was statistically significant (P<0.05). Specificity and sensitivity of coagulation and D-dimer were higher than coagulation four, D-D dimer detection. Conclusion Coagulation and D-dimer are great value in the early diagnosis of hypertension and the severity of pregnancy. Joint detection could improve the specificity and sensitivity of diagnosis.
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Objective To explore the application value of serum retinol binding protein(RBP) ,coagulation four indexes and platelet indexes in the auxiliary diagnosis of severe liver disease diagnosis .Methods A total of 110 outpatients and inpatients with severe liver disease in our hospital from January 2014 to December 2015 ,including 43 cases of acute chronic severe hepatitis(group A) ,36 cases of liver cirrhosis(group B) ,and 31 cases of liver cancer patients(group C)] ,38 cases of patients with non severe liver disease and 40 individuals undergoing the healthy physical examination person healthy were selected as the research subjects .RBP , coagulation four indexes[plasma prothrombin time(PT) ,activated partial thromboplastin time(APTT) ,thrombin time(TT) and fi‐brin original quantitative(Fib)] and platelet indexes[platelet count(PLT) ,mean platelet volume(MPV) and platelet distribution width(PDW)] were detected in all the research subjects .Results The levels of RBP ,Fib and PLT in the group A ,B and C of se‐vere liver disease were lower than those in the control group and the non‐severe liver disease ,while the levels of PT ,APTT ,TT , MPV and PDW were significantly higher than those in the control group and the non‐severe liver disease group ,differences were statistically significant(P0 .05) .Conclusion RBP ,coagulation four indexes and platelet indexes are the important detection indicators in the auxiliary diagnosis of severe liver disease ,therefore clinic should strengthen the above indexes detections in the patients w ith severe liver disease .
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Objective To explore the changes and clinical significance of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen time(FGB)and platelet(PLT)on Kawasaki disease(KD)in children with acute and convalescent 10 d,which aimed at early diagnosis,prediction and prognosis of coronary artery lesions.Methods Thirty-eight cases who were diagnosed KD were selected as KD group,30 cases age-matched acute respiratory infections in children with fever as fever group,moreover,30 cases of a class of elective surgery preoperative children admitted to surgical departments were put as control group.The plasma PT,APTT,TT,FGB,PLT of all cases and plasma APTT,FGB,PLT in recovery 10 d in children with KD disease were detected,and then the results were compared between the 3 groups;and the results of APTT,FGB,PLT in KD children with acute and convalescent 10 d to coronary artery dilatation groups or not were compared.Results 1.APTT prolonged and FGB,PLT increased in KD children with acute stage,which had a significant difference compared with other groups(Pa0.05).2.When comparing the results of APTT,FGB,PLT in KD children with acute and convalescent 10 d,the difference was significant(Pa