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Application of Sonoclot analysis in the treatment of patients with traumatic shock with coagulation dysfunction during operations

Clinical Medicine of China, no. 23, February, 2007. February 2007. Vol. 23. No. 2
Sonoclot analysis was performed in patients with traumatic shock
Application of coagulant dysfunction
Chen jianhong, wang yongsheng, wang yongsheng, Mr
[abstract] objective: to analyze the abnormal state of blood coagulation during operation of patients with Sonoclot and to examine the function of coagulation function in the laboratory
The change of coagulation function in patients with period. Methods: in 65 patients, the blood was collected during the three periods of preoperative, 1 h, and intraoperative period, and the Sonoclot analysis was performed.
Determine whether the coagulation factor and dosage are supplemented by laboratory results. Results the results of 65 patients with coagulation function decreased and positive
After supplemental adjustment, the blood function of 1 h was significantly improved, and the results were normal or close to normal. Conclusion the technique is diffuse
The blood can be quickly explained by Sonoclot analysis to determine which aspect of the coagulant substance is defective. Laboratory results from side
Verify the accuracy of Sonoclot analysis. In patients with traumatic shock, the function of coagulation disorder was characterized by coagulation factor and thrombocytopenia
Loss, decrease, lack of priority. The function of platelet in coagulation is closely related to platelet count and platelet aggregation function.
[key words] coagulation dysfunction; Sonoclot analysis; Traumatic shock
[middle image classification number] R 55 [document identification code] B [article number] 1008-6315(2007)02-0168-02
Patients with severe trauma have a large amount of coagulation factor due to the large amount of bleeding
Loss, often appear coagulant function abnormality, if not corrected in time must lead
Abnormal low coagulation in the operation, the surgical wound is diffuse bleeding or diffuse blood
Endovascular coagulation (DIC). This study began in 2002 and passed Sono -
Clot analyses the abnormal state of coagulation during operation and coagulation in the laboratory
Functional examination to study the function of coagulation function in patients with surgery
Bed rescue treatment provides basis.
1 data and methods
1. 1. In the general information, 65 cases of severe traumatic shock have been reported.
Of the 42 cases, 23 were female; Age l7 ~ 56 years old. The liver and spleen rupture
In 34 cases, 23 patients with multiple fractures, open craniocerebral injury and lower limb
Five cases of fracture and three chest abdominal injuries were reported. In preoperative, intraoperative 1h, intraoperative 3
The patient's blood was collected during the period, and the Sonoclot was tested, analyzed and checked
The activation of some thrombin time (APTr), plasma thrombin
(PT), plasma thrombin time (rI), platelet count (BPC),
Fibrinogen (Fib). Intraoperative abnormal infiltration of blood is suspected of DIC
The test of the test of the copulation test (3P test) and D.
The Sonoclot analyzer used is produced and recorded by Sienco
3 indicators: (~) SonACT, which means the blood specimen remains liquid
Time, mainly related to coagulation factor. Fibrin condensation rate,
To further reflect the formation of fibrous protein and the rate of coagulation, and
The fibrinogen level is related. Platelet function represents platelets
Contractile intensity, the Sonoclot marker graph, the understanding of clotting
The whole process, this group study used gbAct test tube.
1. 2 intraoperative treatment of all patients in the operating room immediately
Gram therapy and anesthesia. First the red blood cells and the fresh frozen plasma,
, works,
The blood volume was replenished by the infusion of blood and the infusion fluid
At the time, pay attention to calcium, maintain acid and alkaline electrolyte balance, and maintain the patient's temperature
Normal, and according to the analysis results of Sonoclot, the judgment is at this time
The blood coagulation function of the patient was etched and the blood coagulation was judged
Insufficient material function to determine whether to replenish fibrinogen and thrombin
Compounds, cold precipitation, platelets and other blood products and determine their respective
The dosage.
1. 3 statistical processing of all data is indicated by plus or minus s
Test, P < 0. The difference is significant.
2 the results
Sixty-five patients with concentrated red blood cells (1450 plus or 550)
M1, plasma (1650 plus or minus 450) lTll, fibrinogen (2. 0 ~ 4. 0 g,
Prothrombin complex (300 ~ 600) U; 5 patients were injected with platelet 2O
The u. The preoperative SonACT value and platelet function were significantly longer, fiber
The protein coagulation rate decreased, and the coagulation function of various laboratories examined PT,
TF and APTr were also significantly longer, and fibrinogen and platelet were obvious
Reduced. In 4 cases, the blood infiltration was performed by 3P test and D - 12
All the tests were negative. According to the analysis of Sonoclot, dot product
In addition, the test results of I h showed that the coagulation was coagulant
The function was significantly improved. The results were normal or close to the test results
Often, the surgical wound has no obvious bleeding. See table 1, table 2.
Table 1 Sonoclot analysis (s) of patients with traumatic shock
Author's unit: 362,000 fujian quanzhou city, PLA first eight. Hospital anesthesiology: comparison with preoperative
. 'P
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Clinical Medicine of China, February 2007, Vol 23, No. 2
Table 2 examination of coagulation function during traumatic shock perioperative period (; S)
Note: compared to preoperative, 'P' (0. 05, P of 0. 01; Compared to the technique, P of 0. 05
3 discuss
Patients with severe trauma are hemorrhaged with the loss of red blood cells
Loss of coagulation factors and platelets are also lost, causing coagulation function
A drop or severe anomaly. For a person with traumatic shock, the dot product
The function of coagulation can be enhanced by the shock and the operation of the operation
Monitor and adjust to avoid abnormal bleeding and bleeding
The check. The normal clotting process requires red blood cells, various clotting factors, and small blood
Board, etc. To achieve the clinical hemostatic effect, most coagulation factors
To achieve normal 10% ~ 30%, fibrinogen is normal value
Between 50% and 60%, the thrombin was 40% of normal and platelet was larger
50 X 10 / L ¨ j. In this study, diffuse bleeding can be used
Sonoclot makes a quick explanation, and Sonoclot passes through the fibers
Protein formation, fibrin monomer polymerization, platelet interaction, blood
The clotting and dissolution of clots give us a good understanding of the whole process of clotting, the fibrous eggs
The infusion of white original, cold precipitation, platelet and thrombin is given separately
The coagulation factors were determined by continuous monitoring and analysis
The supplement is in place. Routine ACT (full blood freeze activation time),
AP1T and PT can only show one aspect of coagulation mechanism, their detection
When the fibrin monomer is formed, it is concluded that the coagulation cascade cannot be reflected
And the internal situation of the whole process of the coagulation system j, they reflect the blood coagulation
Solid quantitative indicators do not necessarily reflect the blood clotting conditions of living tissues
Transfusion and blood infusion are blind. Compared to conventional detection
The Sonoclot has obvious advantages over time, and it can go in
A quick test on the edge of the bed, which results in a few minutes; In the analysis of judgment, tong
The curve of the curve is more obvious and can be understood dynamically
The clotting function of the time period is more pertinence in guidance. So I
They can stand on the whole concept of the patient's coagulation work
The state of energy, and the functional state of every part of the clotting material,
Thus, the functional defect of the coagulant substance is determined.
The coagulation factor can be used directly in the treatment of Sonoclot
Supplement, do not wait for AP1T, q3 ", PT and other laboratory results, and this research
The results of the lab test also verified the Sonoclot points from the other side
The accuracy of the analysis. This study also shows that patients with traumatic shock have surgery
The characteristics of the coagulant dysfunction, the coagulation factor, platelet loss
Loss, decrease, lack of priority, cause coagulation time prolonged, Son -
The value of ACT, the function of platelet function, the protein coagulation rate
Decline. In this study, the above cases were not developed as DIC, possibly with
Our early enhanced processing does not indicate that patients with severe trauma are not
It will evolve into DIC, so it is important to strengthen the monitoring of DIC
Sonoclot analysis was used to adjust the coagulation phase early and specifically
To minimize the occurrence of the above situation.
The study found that the function of platelets in clotting was not involved in blood
The plate count is also closely related to the platelet aggregation function of the patient.
In some patients, the platelet count is lower than 50 X 10 / L, but Sonoclot
The function of platelet function is still available. Some patients have platelet count
It's more than 50 X 10 / L, but Sonoclot shows low platelet function,
Platelets must be injected to improve the patient's coagulation function. We are in
In clinical treatment, five patients were given blood transfusion based on this analysis
Small plates, improved their overall coagulation function, so platelet counts
The aggregation function is larger than the individual platelet count
Clinical significance.
Attention should be paid to the treatment of coagulant dysfunction in patients
Once again blood loss and infusion can result in coagulation factor dilution, blood transfusion
Citrate of citrate, hyperfibrinolysis, hypothermia and electrolytes caused by trauma
Disorders can affect the coagulation function, and in the operation these aspects should also be at the same time
Make adjustments. We think that through Sonoclot, traumatic shock
The analysis of coagulant dysfunction during perioperative period can cause coagulation dysfunction
The patient receives prompt and accurate treatment, thereby improving the creation of the original
The treatment success rate of patients.
References:
[1] at the same time. Difficult and complicated anesthesiology [M]. Beijing: China medical science and technology press,
1996:1996-151.
[2] deng caiying, xl~d, Ming. Sonoclot coagulation and platelet function analyzers are in clinical practice
[J]. Foreign medical anesthesia and resuscitation, 2001, 22(3) : 168.
[abstract 2006-10-10]
(in this article, we will edit the chrysanthemum)
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