背景:粘弹性测试的使用正变得越来越流行。缺乏对不同凝血状态的可重复性的验证。因此,我们旨在研究ROTEM的变异系数(CV)EXTEM参数凝血时间(CT),凝块形成时间(CFT),血液中α角和最大凝块硬度(MCF)具有不同程度的凝血强度。假设是在低凝状态下CV增加。
方法:纳入了危重患者和在大学医院接受神经外科手术的患者。每个血液样本在八个平行通道中进行测试,生成测试变量的CV。在25名患者中,在基线和用白蛋白5%稀释后分析血液样本,以及在掺入纤维蛋白原后,模拟弱和强凝固。
结果:总计,从91名患者中收集了225份独特的血液样本。在八个平行的ROTEM通道中分析所有样品,产生1800次测量。在低凝样品中,定义为那些值超出正常参考范围的值,CT的CV(中位数(四分位距))(6.3%(5.1-9.5))高于可正常凝固的样品(5.1%(3.6-7.5)),p<0.001。CFT没有差异(p=0.14),而α角的CV在低凝样品中(3.6%(2.5-4.6))高于在正常凝固样品中(1.1%(0.8-1.6),p<0.001。低凝样品(1.8%(1.3-2.6))的MCFCV高于正常凝固样品(1.2%(0.9-1.7)),p<0.001。不同变量的CV范围如下:CT:1.2%-37%,CFT:1.7%-30%,阿尔法角:0.0%-17%,MCF:0.0%-8.1%。
结论:EXTEMROTEM参数CT的CV,α角,与正常凝血的血液相比,低凝性血液中的MCF增加,证实了CT的假设,α角,和MCF,但不是CFT。此外,CT和CFT的CV远高于α角和MCF。结果表明,应使用有限精度的概念来解释凝血功能较弱的患者的EXTEMROTEM结果,仅基于ROTEMEXTEM,应该谨慎对待。
BACKGROUND: The use of viscoelastic tests is becoming increasingly popular. There is a paucity of validation of the reproducibility of varying coagulation states. Therefore, we aimed to
study the coefficient of variation (CV) for the
ROTEM EXTEM parameters clotting time (CT), clot formation time (CFT), alpha-angle and maximum clot firmness (MCF) in blood with varying degrees of coagulation strength. The hypothesis was that CV increases in states of hypocoagulability.
METHODS: Critically ill patients and patients subjected to neurosurgery at a university hospital during three separate periods were included. Each blood sample was tested in eight parallel channels, yielding the CVs for the tested variables. In 25 patients, the blood samples were analysed both at baseline and after dilution with albumin 5%, as well as after being spiked with fibrinogen, simulating weak and strong coagulation.
RESULTS: In total, 225 unique blood samples were collected from 91 patients. All samples were analysed in eight parallel
ROTEM channels, resulting in 1,800 measurements. In hypocoagulable samples, defined as those with values outside the normal reference range, the CV of CT was higher (median (interquartile range)) (6.3% (5.1-9.5)) than for normocoagulable samples (5.1% (3.6-7.5)), p < 0.001. CFT showed no difference (p = 0.14), while the CV of alpha-angle was higher in hypocoagulable samples (3.6% (2.5-4.6)) than in normocoagulable samples (1.1% (0.8-1.6), p < 0.001. The CV of MCF was higher in hypocoagulable samples (1.8% (1.3-2.6)) than in normocoagulable samples (1.2% (0.9-1.7)), p < 0.001. The CV ranges for the different variables were as follows: CT: 1.2%-37%, CFT: 1.7%-30%, alpha-angle: 0.0%-17% and MCF: 0.0%-8.1%.
CONCLUSIONS: CVs for the EXTEM
ROTEM parameters CT, alpha-angle, and MCF increased in hypocoagulable blood compared to blood with normal coagulation, confirming the hypothesis for CT, alpha-angle, and MCF but not for CFT. Furthermore, the CVs for CT and CFT were much higher than those for alpha-angle and MCF. The results demonstrate that EXTEM
ROTEM results from patients with weak coagulation should be interpreted with the notion of limited precision and that procoagulative treatment, based only on
ROTEM EXTEM, should be given with some caution.