Journal of practical medicine, no. 16, volume 30, 2014
· clinical research ·
Doi: 10. 3969 / j. Issn. 1006 a pride 5725.2014.16. 012
Fund project: national natural science fund (no. : 81101406)
Author: 510515 guangzhou, southern medical university (wanpeng); 510010 south
Medical university affiliated to guangzhou military district guangzhou general hospital of the intensive care of the whole military area trauma treatment and
Organize and repair key laboratory (tong Watson, zhang xingqin, duan pengkai, tang pomelo qing, su lei)
Communication author: su lei E - mail: slei_icu @163. com
Severe heat stroke is a type of exposure to high heat or high energy
Dynamic conditions, the center temperature by more than 40 ℃ and central
Neurological dysfunction can cause delirium, convulsion or coma
A severe disease of symptoms [1-2]. In severe heat death direct phase
In the factors of correlation [3-4], the coagulation disorder has gradually been more and more developed
The systematic inflammatory response caused by thermal stimulation (SIRS)
The formation of coagulation disorders can be initiated, which may lead to dispersion
Dic (disseminated intravascular coagulation,
DIC) formation. Patients with severe heat stroke are more likely to become ill
In a matter of hours, the symptoms of hemorrhage, manifested in obvious and extensive symptoms,
There are also extensive microthrombosis, which can lead to blood flow
Mechanical disorders, hypoxia of the affected organs, resulting in tissue necrosis
Multiple organ failure. About DIC monitoring, so far
There are no single specific indicators of specificity in the world
Sonoclot analyzer is in severe heat stroke and disseminated intravascular coagulation
Diagnostic value
Wanpeng tong Watson zhang xingqin duan - peng kaitang youth su lei
Objective: to evaluate the blood coagulation analyzer (Sonoclot) and platelet function of severe heatstroke complicated with disseminated intravascular coagulation (disseminated
The diagnostic value of intravascular coagulation, DIC). Methods: retrospective analysis of patients with coagulant dysfunction in severe heatstroke was analyzed
The thrombosis and hemostasis (ISTH) score was divided into 22 cases of dominant DIC group, not explicit
In 21 cases of the sexual DIC group, the general clinical data of the two groups were compared, and routine coagulation index, blood routine, d-dimer and Sonoclot instruments were examined
Measurement. The analysis of the Sonoclot index (ACT, CR, PF) and patients was analyzed using single factor Logistic regression analysis. The ROC curve
Analysis of DIC diagnostic value of Sonoclot instrument index. Results: there was no difference between the two groups in age, gender, central body temperature and hospital stay
And ICU length of hospital stay, DIC symptoms, prognosis, ISTH score, APACHE Ⅱ score differences between the two groups was statistically significant (P < 0. 05).
There is a good correlation between the ACT, CR and DIC of Sonoclot instruments (P < 0). 05), ACT, ACT combined CR in ROC
The area under the curve is 0. 854 and 0. The difference was statistically significant (P < 0. 01), the ACT diagnostic DIC specificity is 69. 2 percent sensitivity is
90. 3%, when ACT combined CR, sensitivity rose to 80. 2 percent, the specificity is 93. 5%. Conclusion: Sonoclot analyzer can treat severe heatstroke
DIC makes rapid diagnosis and is an effective choice for clinical diagnosis of DIC.
Keywords severe heat stroke; Coagulation and platelet function analyzer; Disseminated intravascular coagulation

Ｔｈｅ ｄｉａｇｎｏｓｔｉｃ ｖａｌｕｅ ｏｆ Ｓｏｎｏｃｌｏｔ ｉｎ ｔｈｅ ｄｉａｇｎｏｓｉｓ ｏｆ ｈｅａｔ ｓｔｏｋｅ ｃｏｍｐｌｉｃａｔｅｄ ｗｉｔｈ ＤＩＣ ａｎｄ ｈｅａｔ ｓｔｒｏｋｅ ＷＡＮ
Ｐｅｎｇ， ＴＯＮＧ Ｈｕａ鄄ｓｈｅｎｇ， ＺＨＡＮＧ Ｘｉｎｇ鄄ｑｉｎ， ＤＵＡＮ Ｐｅｎｇ鄄ｋａｉ， ＴＡＮＧ Ｙｏｕ鄄ｑｉｎｇ， ＳＵ Ｌｅｉ． Ｓｏｕｔｈｅｒｎ Ｍｅｄｉｃａｌ
Ｕｎｉｖｅｒｓｉｔｙ， Ｇｕａｎｚｈｏｕ ５１０５１５， Ｃｈｉｎａ．
Ｃｏｒｒｅｓｐｏｎｄｉｎｇ ａｕｔｈｏｒ： ＳＵ Ｌｅｉ Ｅ鄄ｍａｉｌ：ｓｌｅｉ＿ｉｃｕ＠１６３．ｃｏｍ
【Ａｂｓｔｒａｃｔ】Ｏｂｊｅｃｔｉｖｅ Ｔｏ ｅｖａｌｕａｔｅ ｄｉａｇｎｏｓｔｉｃ ｖａｌｕｅ ｏｆ Ｓｏｎｏｃｌｏｔ ｉｎ ｔｈｅ ｄｉａｇｎｏｓｉｓ ｏｆ ｈｅａｔ ｓｔｒｏｋｅ ｃｏｍｐｌｉｃａｔｅｄ
ｗｉｔｈ ｄｉｓｓｅｍｉｎａｔｅｄ ｉｎｔｒａｖａｓｃｕｌａｒ ｃｏａｇｕｌａｔｉｏｎ （ＤＩＣ）． Ｍｅｔｈｏｄｓ ４３ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｈｅａｔ ｓｔｒｏｋｅ ａｎｄ ｃｏａｇｕｌａｔｉｏｎ
ｄｙｓｆｕｎｃｔｉｏｎ ｗｅｒｅ ｒｅｔｒｏｓｐｅｃｔｉｖｅｌｙ ｉｎｃｌｕｄｅｄ ａｎｄ ｄｉｖｉｄｅｄ ｉｎｔｏ ２ ｇｒｏｕｐｓ ａｃｃｏｒｄｉｎｇ ｔｏ ｓｃｏｒｅｓ ｂｙ Ｉｎｔｅｒｎａｔｉｏｎａｌ Ｓｏｃｉｅｔｙ ｏｆ
Ｔｈｒｏｍｂｏｓｉｓ ａｎｄ Ｈｅｍｏｓｔａｓｉｓ （ＩＳＴＨ）： ＤＩＣ ｄｏｍｉｎａｎｔ ｇｒｏｕｐ （２２ ｃａｓｅ） ａｎｄ ＤＩＣ ｎｏｎ鄄ｄｏｍｉｎａｎｔ ｇｒｏｕｐ （２１ｃａｓｅ）．
Ｒｅｇｕｌａｒ ｃｏａｇｕｌａｔｉｏｎ ｔｅｓｔｓ， ｒｏｕｔｉｎｅ ｂｌｏｏｄ ｔｅｓｔ， Ｄ鄄ｄｉｍｅｒ ａｎｄ Ｓｏｎｏｃｌｏｔ ｔｅｓｔｓ ｗｅｒｅ ｐｅｒｆｏｒｍｅｄ ａｔ ａｄｍｉｓｓｉｏｎ ａｎｄ ｔｈｅｉｒ
ｃｌｉｎｉｃａｌ ｄａｔａ ｗｅｒｅ ｃｏｍｐａｒｅｄ． Ｌｏｇｉｓｔｉｃ ｒｅｇｒｅｓｓｉｏｎ ａｎａｌｙｓｉｓ ｗａｓ ａｐｐｌｉｅｄ ｔｏ ｅｖａｌｕａｔｅ ｔｈｅ ｒｅｌａｔｉｏｎｓｈｉｐｓ ｂｅｔｗｅｅｎ ＤＩＣ
ｏｃｃｕｒｒｅｎｃｅ ａｎｄ Ｓｏｎｏｃｌｏｔ ｐａｒａｍｅｔｅｒｓ． ＲＯＣ ｃｕｒｖｅｓ ｗｅｒｅ ｕｓｅｄ ｔｏ ｅｖａｌｕａｔｅ ｄｉａｇｎｏｓｔｉｃ ｖａｌｕｅ ｏｆ Ｓｏｎｏｃｌｏｔ ｆｏｒ ｔｈｅ ｐａｔｉｅｎｔｓ
ｗｉｔｈ ＤＩＣ ａｎｄ ｈｅａｔ ｓｔｒｏｋｅ． Ｒｅｓｕｌｔｓ Ｔｈｅｒｅ ｗｅｒｅ ｎｏ ｄｉｆｆｅｒｅｎｃｅｓ ｉｎ ａｇｅ， ｓｅｘ， ｃｅｎｔｒａｌ ｔｅｍｐｅｒａｔｕｒｅ ａｎｄ ｔｏｔａｌ ｈｏｓｐｉｔａｌ
ｓｔａｙ ｂｅｔｗｅｅｎ ｔｈｅ ２ ｇｒｏｕｐｓ ｅｘｃｅｐｔ ＩＣＵ ｓｔａｙ， ＤＩＣ ｓｙｍｐｔｏｍｓ， ｏｕｔｃｏｍｅ， ＩＳＴＨ ｓｃｏｒｅｓ ａｎｄ ＡＰＡＣＨＥⅡｓｃｏｒｅｓ （Ｐ ＜
０．０５）． ＡＣＴ ａｎｄ ＣＲ ｃｏｒｒｅｌａｔｅｄ ｗｉｔｈ ｔｈｅ ｏｃｃｕｒｒｅｎｃｅ ｏｆ ＤＩＣ （Ｐ ＜ ０．０５）． Ｔｈｅ ＡＵＣ ｏｆ ＡＣＴ ａｎｄ ＡＣＴ ｃｏｍｂｉｎｅｄ ｗｉｔｈ
ＣＲ ｗｅｒｅ ０．８５４ ａｎｄ ０．８７７ ｒｅｓｐｅｃｔｉｖｅｌｙ． Ｔｈｅ ｓｐｅｃｉｆｉｃｉｔｙ ｏｆ ＡＣＴ ｉｎ ｐｒｅｄｉｃｔｉｎｇ ＤＩＣ ｗａｓ ６９．２％ ｗｉｔｈ ｔｈｅ ｓｅｎｓｉｔｉｖｉｔｙ ｏｆ
９０．３％． Ｗｈｅｎ ｃｏｍｂｉｎｅｄ ｗｉｔｈ ＣＲ， ｂｏｔｈ ｔｈｅ ｓｐｅｃｉｆｉｃｉｔｙ ａｎｄ ｔｈｅ ｓｅｎｓｉｔｉｖｉｔｙ ｗｅｒｅ ｉｎｃｒｅａｓｅｄ ｔｏ ８０．２％ ａｎｄ ９３．５％，
ｒｅｓｐｅｃｔｉｖｅｌｙ． Ｃｏｎｃｌｕｓｉｏｎｓ Ｓｏｎｏｃｌｏｔ ｃａｎ ｐｒｅｄｉｃｔ ＤＩＣ ｑｕｉｃｋｌｙ ａｎｄ ｉｓ ｅｆｆｅｃｔｉｖｅ ｉｎ ｔｈｅ ｄｉａｇｎｏｓｉｓ ｏｆ ｈｅａｔ ｓｔｒｏｋｅ
ｐａｔｉｅｎｔｓ ｗｉｔｈ ＤＩＣ．
【Ｋｅｙ ｗｏｒｄｓ】Ｈｅａｔ ｓｔｒｏｋｅ； Ｓｏｎｏｃｌｏｔ； Ｄｉｓｓｅｍｉｎａｔｅｄ ｉｎｔｒａｖａｓｃｕｌａｒ ｃｏａｇｕｌａｔｉｏｎ
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Table 1 clinical indicators of the two groups of patients were x plus or minus s
index
Gender (male/female)
Age (year)
Hospitalization time (d)
ICU hospitalization time (d)
APACHE Ⅱ score
ISTH score
Core body temperature (℃)
DIC clinical symptoms (yes/no, cases)
Prognosis (survival/death, case)
Dominant DIC group
(n = 22)
21/1
23 + 6
18 + 17
7 + 3
24 + 6
5 + 1
40 + 1
9/13
17/5
Nondominant DIC group
(n = 21)
20/1
25 + 7
12 plus or minus 10
4 + 3
12 + 3
2 + 1
39 + 1
2/19
20/1
P values
> 0. 05
> 0. 05
> 0. 05
< 0. 05
< 0. 05
< 0. 001
> 0. 05
< 0. 05
< 0. 05
Note: the clinical symptoms of DIC include bleeding from wound surface and the form of extensive blotchy spots of the skin
To form, spontaneous viscera hemorrhage and so on
Table 2 Sonoclot index single factor regression analysis results
index
The ACT
CR
PF
P values
0. 000
0. 005
0. 278
The OR
1. 018
1. 056
0. 784
95% CI of OR value
1. 008-1. 028
1. 017-1. 096
0. 504-1. 217
Do not detect the different pathways of the coagulation cascade, some of the detection conditions
High requirements, long time, high cost, and individual items can't be reversed
The overall condition of the coagulation function of the patients [5]. A search is urgently needed
Rapid, simple, intuitive and feasible detection means applied to the clinical association
The diagnosis of DIC and provide basis for targeted treatment. Coagulation and
Platelet function analyzer (Sonoclot) adequately reflects the coagulation factor
Status, platelet function, comprehensive evaluation of blood coagulation process
And the interaction between clotting factors and platelets. Not yet
Sonoclot is used to evaluate the functional disorders of heatstroke in severe cases.
The purpose of this study was to observe the routine coagulation function of severe heat stroke
Sonoclot index was changed, and Sonoclot was evaluated by ROC curve
The diagnostic value of DIC in severe heatstroke.
1 object and method
1. 1 research object from January 2010 to October 2013
Severe medical science (ICU) in guangzhou general hospital of the state military district
There were 43 cases of heatstroke.
1. 2 diagnostic criteria are in line with the national occupational heat stroke diagnostic standard
The principle of alignment and processing, DIC's diagnosis reference 2001 international thrombus
The DIC professional committee of hemohemostatic society sets the standard [6].
1. Elimination of the standard other causes of platelet change
Such as thrombocytopenia purpura, hypersplenic hyperfunction or taking causes coagulation
Drugs with abnormal blood function or reduced platelets; Age < 18 years old.
1. The study group records the general clinical data of patients, according to the state
International association of blood clots and hemostasis (ISTH)/scientific standardization society (SSC)
The dominant DIC rating criteria were published in 2001
For the dominant DIC group (DIC score is greater than 5, total 22 cases), non-dominant
DIC group (DIC score < 5, total 21 cases).
1. 5. After the experimental method was entered into the family, the peripheral blood samples were collected and carried out
Detection of coagulation index. Blood samples were collected and reduced immediately
Excessive body temperature, correct water, electrolyte balance disorder and acid base balance
Dissonance, immune conditioning, active organ support and prevention of shock and shock
Brain edema and other symptomatic support therapy.
1. 5. 1 general clinical data records the age, gender, and center of the patient
Temperature (ear temperature), total hospital stay, ICU length of stay, multiple times
Blood, case fatality rate, APACHE Ⅱ score, ISTH score.
1. 5. 2. Routine coagulation index detection (1) platelet count
(PLT); (2) fibrinogen (FBG); (3) prothrombin time
(PT); (4) activation of partial thrombin time (APTT); (5)
International standardized ratio (INR); (6) d-dimer.
1. 5. 3 Sonoclot analyzer index determination was activated through in vitro
The endogenous coagulation pathway is used to simulate the whole process of coagulation. Analyzer tube type
The probe moves through the blood sample, through an electronic signal converter
The displacement impedance changes through the Signature viewer attached to the analyzer
The computer software finishes the liquid phase with the blood sample (fibrin
The strength and velocity of coagulation contraction after polysomal formation
Calculate the relative value of each point of the curve in the process
Recording Sonoclot's quantitative indexes: activating the blood clotting time (ACT), fiber
Protein coagulation rate (CR) and platelet function (PF). Sonoclot
The normal range of each parameter is: ACT 119 ~ 195 s, CR 7
-23, PF is greater than 1. 5.
1. 6 statistical methods were adopted SPSS 19. Version 0 statistics software
Line analysis. The measured data is expressed as the mean or minus standard deviation. In nonparametric
The method is used to construct the ROC curve of the Sonoclot analyzer
The offline area, and determine the optimal diagnostic critical point, calculate the various indicators
The sensitivity and specificity of DIC. Measurement data adopts t test, meter
The data was verified by chi-square test, and the correlation was single factor Logistic
Regression analysis. It's going to be P < 0. The difference was statistically significant.
2 the results
2. A total of 43 patients were collected in one or two groups of patients
The ISTH score standard was divided into 22 cases: male 22
For example, the average age of female is (23 + 6) years; Nondominant DIC is
21 cases: 20 male cases and 1 female, with an average age of 25 + 7 years.
The clinical indicators of the two groups were shown in table 1.
2. 2 correlation analysis of Sonoclot index and DIC score
Using single factor Logistic regression analysis to the Sonoclot index (ACT,
CR, PF) was analyzed with the patient's occurrence of DIC (table 2).
2. The working curve of the subject (ROC) was constructed by non-parametric method
The working curve of the test subjects was used to calculate the ROC of the diagnostic DIC of each coagulation index
The area under the curve (AUC) is calculated and the sensitivity of different indexes is calculated
Specificity (table 3, figure 1).
3 discuss
In severe heat stroke death, the coagulant function is the direct correlation factor
Disorder has gradually been paid attention to by more researchers, caused by thermal stimulation
Systemic inflammatory response syndrome can initiate coagulation disorders
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Figure 1. The ROC curve of different coagulation indexes
Table 3 the area under different coagulation index curve and the hypothesis test results
index
APTT
PT
INR
PLT
FBG
D - dimer
The ACT
CR
PF
The ACT + CR
cutoff
56. 8
19. 8
1. 63
90
2. 6
3790
231
13. 6
1. 95
-
Sensitivity (%)
61. 5
76. 9
80. 8
26. 9
54. 8
80. 8
69. 2
92. 3
38. 5
80. 2
Specificity (%)
83. 9
87. 1
93. 5
16. 1
45. 2
70. 2
90. 3
48. 4
45. 2
93. 5
AUC
0. 828
0. 857
0. 919
0. 215
0. 182
0. 828
0. 854
0. 738
0. 420
0. 877
95% CI
0. 713-0. 942
0. 755-0. 958
0. 840-0. 998
0. 070-0. 293
0. 081-0. 349
0. 721-0. 935
0. 753-0. 955
0. 611-0. 865
0. 267-0. 573
0. 790-0. 964
P values
< 0. 001
< 0. 001
< 0. 001
< 0. 001
< 0. 001
< 0. 001
< 0. 001
< 0. 001
< 0. 001
< 0. 001
[7]. The excessive release of inflammatory media causes endothelial cell injury and inflammation
Activation of the sex cells, while activating the coagulation system, causes clotting - resistance
The coagulation system is disturbed, which causes a large amount of coagulation factor activation and thrombin generation
And the inhibition of physiological anticoagulation and the decrease of fibrinolytic activity resulted in the result
The fibrinoprotein is produced in large amount, the microcirculation dysfunction, and then the guide
Tissue ischemia, hypoxia, organ failure [8-10]. In this study
In comparison of patients with coagulant dysfunction, the combination was found
Dominant DIC patients with ICU length of hospital stay, APACHE Ⅱ
The scores were significantly higher, indicating that the coagulant dysfunction was associated with severe heatstroke
The patient was critically ill with poor prognosis and high fatality. Therefore, timely diagnosis
And effective treatment can block the vicious cycle of severe heat stroke,
It is the key to reduce the mortality of patients. Routine coagulation screening is solid
Tests, such as PT, APTT, etc. were used to detect the different reactions of coagulation cascade
Path, and each item alone does not reflect the patient's coagulation function
Overall condition. Thrombin - antithrombin complex (TAT), thrombin
Some specific analysis markers such as the original activated peptide (F1 +2 fragment) were correct
DIC has a definite value, but it requires a specific kit, which is expensive,
Tests that cannot be used for individual specimens and emergency specimens are difficult to verify
The international clinical examination was popularized [11-13]. The diagnosis of severe heat stroke in severe cases
So far, there is no single specific target for diagnosis in the world
Combined with classic DIC diagnostic criteria and clinical manifestations and inflammation
The reaction degree was analyzed dynamically. The eighth national blood clot
The standard of hemostasis academic conference is not quantified, some indicators
False positive and false negative, diagnostic sensitivity and specificity, right
No help was found in the diagnosis and prognosis of the disease. International diagnostic review
The system adopts conventional coagulation experiment and is easy to promote and dynamic score
The process of coagulation was analyzed, but the various scoring systems were given to DIC
There is a difference in broken value [6, 11-15]. In recent years, clotting and platelet work
The Sonoclot is widely used in clinical practice and can be used for continuity
The accuracy of monitoring is higher than that of conventional coagulation test. It includes to
Lower parameters: ACT, which mainly reflects the function of coagulation factor, is the monitoring of liver
An important index of anticoagulation of vegetarian and low-molecular heparin; CR, which reflects fiber eggs
The rate of white formation, which indirectly reflects the level of fibrinogen, is near
More accurate monitoring of fibrinogen in bed; PF is the only one
Accurate and quantitative monitoring of platelet function. The instrument has a
Lower function [16-19] : (1) identification of high coagulation and low coagulation; (2) monitoring drugs
Effects of substance on coagulation function; (3) monitoring platelet function and prediction
Postoperative bleeding can be used to guide the supplement of the clotting substrate. (4) differentiation
Primary fibrinolytic hyperlysis and secondary hyperfibrinolysis.
Studies have shown that [17, 20] use the Sonoclot analyzer to predict clinical hemostasis
The accuracy rate is much higher than that of conventional coagulation experiment
The inhibition of platelet activation was detected in the absence of baseline parameters
In the test, the Sonoclot analyzer signal structure changes to blood
Small plate dysfunction has better guidance. In this study, because
The number of samples is limited, and the multi-factor analysis cannot be conducted to select the independent crisis
Risk factors. Therefore, we use the single factor Logistic regression analysis
DIC analysis was performed on the Sonoclot index and the patient's occurrence.
The results show that both ACT and CR are < 0. 01, explain ACT, CR and
DIC has a good correlation. At the same time, we pass the meter
Calculate the area under the ROC curve of different coagulation related indicators
The best diagnostic critical point of coagulant function index is the DIC diagnostic marker
To further evaluate the parameters of Sonoclot analyzer in the diagnosis of DIC
Of value. The results show that the area under the INR curve is the largest and the specific
High sex and sensitivity. By comparing with the traditional coagulation index,
The area under the ACT curve is 0. In 854, DIC specificity is only diagnosed
69. 2 percent, but sensitivity is 90. The difference was statistically significant (P
< 0. 01). Because DIC is not a single change, it is a complex one
Syndrome, the effects of different parameters at different stages are different for the purpose of study
The combined effect of the various indexes of Sonoclot, we combined ACT and CR
Line diagnostic analysis, the results show that ACT combined CR, sensitivity
Rise to 80. 2 percent, the specificity is 93. 5%. Note that DIC is not diagnosed
A single index should be considered, and a comprehensive assessment should be conducted.
In this study, although traditional coagulation indicators such as INR were sensitive
Sex and specificity are high, but these indicators only reflect part of the stage
The blood coagulation condition, and the detection time is longer, cannot reflect effectively
Clinical process. About the difference in diagnostic effectiveness between indicators
Main reasons, on the one hand, because of the study sample size is limited, on the other
On the one hand, we consider for DIC is not a single some kind of pathological change
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, but a combination of bleeding, blood coagulation, fibrinolytic disorders into one
Complex syndrome in different stages have different effects on every parameter.
Sonoclot analyzer is fast, low consume materials, can provide the whole
Coagulation process, and the characteristics of the continuous monitoring, can be more comprehensive evaluation
For blood coagulation factor, fibrous protein, platelet function change, so on
DIC diagnostic value have more advantages than traditional coagulation index.
To sum up, Sonoclot as a new type of coagulation analyzer
Blood function monitoring instrument, can occur in patients with severe heatstroke clotting
Dysfunction and diagnosis for blood coagulation dysfunction
For new ideas and strategies.
4 references

Ｂｏｕｃｈａｍａ Ａ， Ｋｎｏｃｈｅｌ ＪＰ． Ｈｅａｔ Ｓｔｒｏｋｅ ［Ｊ］． Ｎ Ｅｎｇｌ Ｊ Ｍｅｄ，
２００２，３４６：１９７８－１９８８．
Ｃａｓａ Ｄ Ｊ， Ａｒｍｓｔｒｏｎｇ Ｌ Ｅ， Ｋｅｎｎｙ Ｇ Ｐ， ｅｔ ａｌ． Ｅｘｅｒｔｉｏｎａｌ ｈｅａｔ
ｓｔｒｏｋｅ： ｎｅｗ ｃｏｎｃｅｐｔｓ ｒｅｇａｒｄｉｎｇ ｃａｕｓｅ ａｎｄ ｃａｒｅ ［Ｊ］． Ｃｕｒｒ Ｓｐｏｒｔｓ
Ｍｅｄ Ｒｅｐｏｒｔｓ， ２０１２， １１（３）： １１５－１２３．
Ｌｅｖｉ Ｍ， ｖａｎ ｄｅｒ Ｐｏｌｌ Ｔ． Ｄｉｓｓｅｍｉｎａｔｅｄ ｉｎｔｒａｖａｓｃｕｌａｒ ｃｏａｇｕｌａｔｉｏｎ：
ａ ｒｅｖｉｅｗ ｆｏｒ ｔｈｅ ｉｎｔｅｒｎｉｓｔ ［Ｊ］． Ｉｎｔｅｒ Ｅｍｅｒｇ Ｍｅｄ， ２０１３， ８（１）：
２３－３２．
Ｌｅｏｎ Ｌ Ｒ， Ｈｅｌｗｉｇ Ｂ Ｇ． Ｈｅａｔ ｓｔｒｏｋｅ： ｒｏｌｅ ｏｆ ｔｈｅ ｓｙｓｔｅｍｉｃ
ｉｎｆｌａｍｍａｔｏｒｙ ｒｅｓｐｏｎｓｅ ［Ｊ］． Ｊ Ａｐｐｌｉｅｄ Ｐｈｙｓｉｏｌ， ２０１０， １０９（６）：
１９８０－１９８８．
Ｌｅｖｉ Ｍ， Ｍｅｉｊｅｒｓ ＪＣ． ＤＩＣ： ｗｈｉｃｈ ｌａｂｏｒａｔｏｒｙ ｔｅｓｔｓ ａｒｅ ｍｏｒｅ ｕｓｅｆｕｌ
［Ｊ］． Ｂｌｏｏｄ Ｒｅｖ，２０１１， ２５： ３３－３７．
Ｔａｙｌｏｒ ＦＢ Ｊｒ， Ｔｏｈ ＣＨ， Ｈｏｏｔｓ ＷＫ， ｅｔ ａｌ． Ｔｏｗａｒｄｓ ｄｅｆｉｎｉｔｉｏｎ，
ｃｌｉｎｉｃａｌ ａｎｄ ｌａｂｏｒａｔｏｒｙ ｃｒｉｔｅｒｉａ， ａｎｄ ａ ｓｃｏｒｉｎｇ ｓｙｓｔｅｍ ｆｏｒ
ｄｉｓｓｅｍｉｎａｔｅｄ ｉｎｔｒａｖａｓｃｕｌａｒ ｃｏａｇｕｌａｔｉｏｎ鄄ｏｎ ｂｅｈａｌｆ ｏｆ ｔｈｅ Ｓｃｉｅｎｔｉｆｉｃ
Ｓｕｂｃｏｍｍｉｔｔｅｅ ｏｎ ｄｉｓｓｅｍｉｎａｔｅｄ ｉｎｔｒａｖａｓｃｕｌａｒ ｃｏａｇｕｌａｔｉｏｎ （ＤＩＣ）
ｏｆ ｔｈｅ Ｉｎｔｅｒｎａｔｉｏｎａｌ Ｓｏｃｉｅｔｙ ｏｎ Ｔｈｒｏｍｂｏｓｉｓ ａｎｄ Ｈａｗｍｏｓｔａｓｉｓ
（ＩＳＴＨ） ［Ｊ］． Ｔｈｒｏｍｂ Ｈａｅｍｏｓｔ， ２００１，８６：１３２７－１３３０．
Ｒｏｂｅｒｔｓ ＧＴ，Ｇｈｅｂｅｈ Ｈ，Ｃｈｉｓｈｔｉ ＭＡ，ｅｔ ａｌ． Ｍｉｃｒｏｖａｓｃｕｌａｒ ｉｎｊｕｒｙ，
ｔｈｒｏｍｂｏｓｉｓ，，ｉｎｆｌａｍｍａｔｉｏｎ，ａｎｄ ａｐｏｐｔｏｓｉｓ ｉｎ ｔｈｅ ｐａｔｈｏｇｅｎｅｓｉｓ ｏｆ
ｈｅａｔｓｔｒｏｋｅ： ａ ｓｔｕｄｙ ｉｎ ｂａｂｏｏｎ ｍｏｄｅｌ ［Ｊ］． Ａｒｔｅｒｉｏｓｃｌｅｒ Ｔｈｒｏｍｂ
Ｖａｓｃ Ｂｉｏｌ，２００８，２８ （６） ： １１３０－１１３６．
Ｂｏｕｃｈａｍａ Ａ， Ｏｌｌｉｖｉｅｒ Ｖ， Ｒｏｂｅｒｔｓ Ｇ， ｅｔ ａｌ． Ｅｘｐｅｒｉｍｅｎｔａｌ ｈｅａｔ
ｓｔｒｏｋｅ ｉｎ ｂａｂｏｏｎ：ａｎａｌｙｓｉｓ ｏｆ ｔｈｅ ｓｙｓｔｅｍｉｃ ｉｎｆｌａｍｍａｔｏｒｙ ｒｅｓｐｏｎｓｅ
［Ｊ］． Ｓｈｏｃｋ，２００５，２４（４）：３３２－３３５．
Ｌｕ ＫＣ， Ｗａｎｇ ＪＹ， Ｌｉｎ ＳＨ， ｅｔ ａｌ． Ｒｏｌｅ ｏｆ ｃｉｒｃｕｌａｔｉｎｇ ｃｙｔｏｋｉｎｅｓ
ａｎｄ ｃｈｅｍｏｋｉｎｅｓ ｉｎ ｅｘｅｒｔｉｏｎａｌ ｈｅａｔｓｔｒｏｋｅ ［Ｊ］． Ｃｒｉｔ Ｃａｒｅ Ｍｅｄ，
２００４，３２（２）：３９９－４０３．
Ｌｉｓａ Ｒ， Ｌｅｏｎ ａｎｄ Ｂｒｙａｎ Ｇ， Ｈｅｌｗｉｇ， ｅｔ ａｌ． Ｈｅａｔ ｓｔｒｏｋｅ： Ｒｏｌｅ ｏｆ
ｔｈｅ ｓｙｓｔｅｍｉｃ ｉｎｆｌａｍｍａｔｏｒｙ ｒｅｓｐｏｎｓｅ ［Ｊ］． Ｊ Ａｐｐｌ Ｐｈｙｓｉｏｌ，２０１０，
１０９：１９８０－１９８８．
Ｗａｄａ Ｈ， Ｔｈａｃｈｉｌ Ｊ， Ｎｉｓｉｏ Ｍ， ｅｔ ａｌ． Ｇｕｉｄａｎｃｅ ｆｏｒ ｄｉａｇｎｏｓｉｓ ａｎｄ
ｔｒｅａｔｍｅｎｔ ｏｆ ｄｉｓｓｅｍｉｎａｔｅｄ ｉｎｔｒａｖａｓｃｕｌａｒ ｃｏａｇｕｌａｔｉｏｎ ｆｒｏｍ
ｈａｒｍｏｎｉｚａｔｉｏｎ ｏｆ ｔｈｅ ｒｅｃｏｍｍｅｎｄａｔｉｏｎｓ ｆｒｏｍ ｔｈｒｅｅ ｇｕｉｄｅｌｉｎｅｓ ［Ｊ］．
Ｊ Ｔｈｒｏｍｂ Ｈａｅｍｏｓｔ， ２０１３， １１（４）：７６１－７６７．
Ｌｅｖｉ Ｍ， Ｔｏｈ ＣＨ， Ｔｈａｃｈｉ Ｊ， ｅｔ ａｌ． Ｇｕｉｄｅｌｉｎｅｓ ｆｏｒ ｔｈｅ ｄｉａｇｎｏｓｉｓ
ａｎｄ ｍａｎａｇｅｍｅｎｔ ｏｆ ｄｉｓｓｅｍｉｎａｔｅｄ ｉｎｔｒａｖａｓｃｕｌａｒ ｃｏａｇｕｌａｔｉｏｎ．
Ｂｒｉｔｉｓｈ Ｃｏｍｍｉｔｔｅｅ ｆｏｒ Ｓｔａｎｄａｒｄｓ ｉｎ Ｈａｅｍａｔｏｌｏｇｙ ［Ｊ］． Ｂｒ Ｊ
Ｈａｅｍａｔｏｌ， ２００９，１４５（１）： ２４－３３．
Ｔｈａｃｈｉｌ Ｊ， Ｔｏｈ ＣＨ， ｅｔ ａｌ． Ｃｕｒｒｅｎｔ ｃｏｎｃｅｐｔｓ ｉｎ ｔｈｅ ｍａｎａｇｅｍｅｎｔ
ｏｆ ｄｉｓｓｅｍｉｎａｔｅｄ ｉｎｔｒａｖａｓｃｕｌａｒｃｏａｇｕｌａｔｉｏｎ ［Ｊ］． Ｔｈｒｏｍｂｏｓｉｓ Ｒｅｓ，
２０１２，１２９（１）：５４－５９．
Ｋａｎｅｋｏ Ｔ， Ｗａｄａ Ｈ． Ｄｉａｇｎｏｓｔｉｃ ｃｒｉｔｅｒｉａ ａｎｄ ｌａｂｏｒａｔｏｒｙ ｔｅｓｔｓ ｆｏｒ
ｄｉｓｓｅｍｉｎａｔｅｄ ｉｎｔｒａｖａｓｃｕｌａｒ ｃｏａｇｕｌａｔｉｏｎ ［Ｊ］． Ｊ Ｃｌｉｎ Ｅｘｐｅｒｉｍｅｎｔ
Ｈｅｍａｔｏｐａｔｈｏｌ， ２０１１， ５１（２）： ６７－７６．
Ｔａｋｅｍｉｔｓｕ Ｔ， Ｗａｄａ Ｈ， Ｈａｔａｄａ Ｔ， ｅｔ ａｌ． Ｐｒｏｓｐｅｃｔｉｖｅ ｅｖａｌｕａｔｉｏｎ
ｏｆ ｔｈｒｅｅ ｄｉｆｆｅｒｅｎｔ ｄｉａｇｎｏｓｔｉｃ ｃｒｉｔｅｒｉａ ｆｏｒ ｄｉｓｓｅｍｉｎａｔｅｄ
ｉｎｔｒａｖａｓｃｕｌａｒ ｃｏａｇｕｌａｔｉｏｎ［Ｊ］． Ｔｈｒｏｍｂｏｓｉｓ ＆ Ｈａｅｍｏｓｔａｓｉｓ， ２０１１，
１０５（１）： ４０．
Ｌｅｅ Ｂ， Ａｌ鄄Ｗａｉｌｉ Ｎ， Ｂｕｔｌｅｒ Ｇ， ｅｔ ａｌ． Ａｓｓｅｓｓｍｅｎｔ ｏｆ ｈｅｐａｒｉｎ
ａｎｔｉｃｏａｇｕｌａｔｉｏｎ ｂｙ Ｓｏｎｏｃｌｏｔ Ａｎａｌｙｚｅｒ ｉｎ ａｒｔｅｒｉａｌ ｒｅｃｏｎｓｔｒｕｃｔｉｏｎ
ｓｕｒｇｅｒｙ［Ｊ］． Ｔｅｃｈｎｏｌ Ｈｅａｌｔｈ Ｃａｒｅ， ２０１１， １９（２）： １０９－１１４．
Ｇａｎｔｅｒ Ｍ Ｔ， Ｈｏｆｅｒ Ｃ Ｋ． Ｐｏｉｎｔ鄄ｏｆ鄄Ｃａｒｅ Ｃｏａｇｕｌａｔｉｏｎ Ｍｏｎｉｔｏｒｉｎｇ
［Ｍ］ ／ ／ Ｍｏｎｉｔｏｒｉｎｇ Ｔｅｃｈｎｏｌｏｇｉｅｓ ｉｎ Ａｃｕｔｅ Ｃａｒｅ Ｅｎｖｉｒｏｎｍｅｎｔｓ［Ｊ］．
Ｓｐｒｉｎｇｅｒ Ｎｅｗ Ｙｏｒｋ， ２０１４： ３２９－３４２．
Ｃａｓｕｔｔ Ｍ， Ｋｒｉｓｔｏｆｆｙ Ａ， Ｓｃｈｕｅｐｆｅｒ Ｇ， ｅｔ ａｌ． Ｅｆｆｅｃｔｓ ｏｎ
ｃｏａｇｕｌａｔｉｏｎ ｏｆ ｂａｌａｎｃｅｄ （１３０ ／ ０．４２） ａｎｄ ｎｏｎ鄄ｂａｌａｎｃｅｄ （１３０ ／
０．４） ｈｙｄｒｏｘｙｅｔｈｙｌ ｓｔａｒｃｈ ｏｒ ｇｅｌａｔｉｎ ｃｏｍｐａｒｅｄ ｗｉｔｈ ｂａｌａｎｃｅｄ
Ｒｉｎｇｅｒ′ ｓ ｓｏｌｕｔｉｏｎ： ａｎ ｉｎ ｖｉｔｒｏ ｓｔｕｄｙ ｕｓｉｎｇ ｔｗｏ ｄｉｆｆｅｒｅｎｔ
ｖｉｓｃｏｅｌａｓｔｉｃ ｃｏａｇｕｌａｔｉｏｎ ｔｅｓｔｓ ＲＯＴＥＭ ａｎｄ ＳＯＮＯＣＬＯＴ［Ｊ］．ＢＪＡ，
２０１０，１０５（３）：２７３－２８１．
Ｂａｂｓｋｉ ＤＭ， Ｂｒａｉｎａｒｄ ＢＭ， Ｒａｌｐｈ ＡＧ， ｅｔ ａｌ． Ｓｏｎｏｃｌｏｔ？
Ｅｖａｌｕａｔｉｏｎ ｏｆ Ｓｉｎｇｌｅ鄄ａｎｄ Ｍｕｌｔｉｐｌｅ鄄Ｄｏｓｅ Ｓｕｂｃｕｔａｎｅｏｕｓ
Ｕｎｆｒａｃｔｉｏｎａｔｅｄ Ｈｅｐａｒｉｎ Ｔｈｅｒａｐｙ ｉｎ Ｈｅａｌｔｈｙ Ａｄｕｌｔ Ｄｏｇｓ［Ｊ］． Ｊ Ｖｅｔ
Ｉｎｔｅｒ Ｍｅｄ， ２０１２， ２６：６３１－６３８．
Ｋｅｈｒｅｌ Ｂ Ｅ， Ｂｒｏｄｄｅ Ｍ Ｆ． Ｓｔａｔｅ ｏｆ ｔｈｅ ａｒｔ ｉｎ ｐｌａｔｅｌｅｔ ｆｕｎｃｔｉｏｎ
ｔｅｓｔｉｎｇ ［Ｊ］． Ｔｒａｎｓｆ Ｍｅｄ Ｈｅｍｏｔｈ， ２０１３， ４０（２）： ７３－８６．２０
（收稿：２０１３－１１－０８ 编辑：陈兵）
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The diagnostic value of Sonoclot analyzer in severe heatstroke and diffuse vascular coagulation
Author: wanpeng, TONG Watson, ZHANG xingqin, DUAN pengkai, tang pomelo qing, su lei, WAN Peng, TONG Hua- sheng, ZHANG Xing- qin, DUAN
Peng- kai, TANG you-qing, SU Lei
Author's unit: wanpeng, WAN Peng (southern medical university, guangzhou, 510515), TONG Watson, ZHANG xingqin, duan pengkai, tang yan-qing, su lei, TONG Hua-sheng,ZHANG
Xing-qin,DUAN peng-kai, TANG you-qing, SU Lei (510010), and the general hospital of severe medicine, guangzhou general hospital of guangzhou military district affiliated to southern medical university
Key laboratory of trauma treatment and tissue repair in hot zone
Title:
Journal of practical medicine
The Journal of Practical Medicine
Year, volume (period) : 2014(16)
This paper links: http://d.g.wanfangdata.com.cn/Periodical_syyxzz201416013.aspx