孕产妇中血栓弹力图的变化及临床意义
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摘要
目的探讨孕产妇中血栓弹力图的变化及临床意义。方法选择2018年1月～2018年12月广西壮族自治区柳州市中医医院就诊孕龄<36周的77例孕妇为观察组1,≥36周的77名孕妇为观察组2,选择同期未孕健康妇女77例为对照组,检测其三组妇女的血栓弹力图(TEG)值、传统凝血指标值;比较三组妇女TEG各参数,存在差异的参数建立参考值范围,对孕妇传统凝血指标与TEG检测结果做相关性分析。结果 TEG各项参数比较,观察组1及观察组2在凝血反应时间(R)、凝血形成时间(K)、血块形成速度(α角度)、最大振幅(MA)、MA确定后30 min纤维蛋白溶解率(LY30)及综合凝血指数(CI)方面与对照组比较,差异有统计学意义(P <0.05)。常规凝血参数上观察组在凝血酶原时间(PT)及活化部分凝血活酶时间(ATPP)与对照组比较,差异有统计学意义(P <0.05)。孕期<36周和≥36周的孕产妇TEG检测指标除LY30明显缩短外(P <0.05),其余指标均无明显变化。观察组TEG与常规凝血参数相关性方面,除α角度外,其他指标的参数值都与传统凝血指标具有一定相关性,PT与MA呈正相关;APTT与R呈正相关,与MA、CI值呈负相关;INR与LY30值呈正相关性;Plt与K值呈负相关,与MA和CI呈正相关;TT与MA呈正相关。结论 TEG能够动态全面的观察孕产妇的凝血功能,根据指标合理有效纠正孕产妇凝血功能,对降低手术风险有重要临床意义。
Objective To explore the changes and clinical significance of thrombus elastograms in pregnant women.Methods From January 2018 to December 2018, 77 pregnant women with gestational age < 36 weeks were selected as the observation group 1, 77 pregnant women with gestational age ≥ 36 weeks as the observation group 2, and 77 healthy women without pregnancy during the same period as the control group. The parameters of TEG of the three groups of women were compared, and the reference value range was established by comparing the different parameters,and the correlation analysis was conducted between the traditional blood coagulation indexes and TEG test results of pregnant women. Results There were statistically significant differences in TEG parameters comparison, pregnant women in the coagulation reaction time(R), clotting time(K), blood clots forming speed(α angle), maximum amplitude(MA), MA determine the rate of 30 min after fibrinolysis(LY30) and synthetic blood clotting index(CI) between observation group 1,2 and control group(P < 0.05). In terms of routine coagulation parameters, there were statistically significance differences between pregnant women and healthy women in prothrombin time(PT) and activated partial thrombin time(ATPP)(P < 0.05). Compared with observation group 1, except LY30, TEG test indexes of observation group 2 were significantly shortened(P < 0.05), there was no significant change in other indexes. In terms of the correlation between TEG and conventional coagulation parameters in pregnant women, except for α angle, the parameter values of other indicators had a certain correlation with traditional coagulation parameters, and PT and MA were positively correlated. APTT was positively correlated with R and negatively correlated with MA and CI. The positive correlation between INR and LY30 was low. Plt was negatively correlated with K value and positively correlated with MA and CI value. TT was positively correlated with MA. Conclusion TEG can dynamically and comprehensively observe the maternal blood coagulation function, and correct the maternal blood coagulation function reasonably and effectively according to the indicators, which has important clinical significance for reducing the surgical risk.
Objective To explore the changes and clinical significance of thrombus elastograms in pregnant women.Methods From January 2018 to December 2018, 77 pregnant women with gestational age < 36 weeks were selected as the observation group 1, 77 pregnant women with gestational age ≥ 36 weeks as the observation group 2, and 77 healthy women without pregnancy during the same period as the control group. The parameters of TEG of the three groups of women were compared, and the reference value range was established by comparing the different parameters,and the correlation analysis was conducted between the traditional blood coagulation indexes and TEG test results of pregnant women. Results There were statistically significant differences in TEG parameters comparison, pregnant women in the coagulation reaction time(R), clotting time(K), blood clots forming speed(α angle), maximum amplitude(MA), MA determine the rate of 30 min after fibrinolysis(LY30) and synthetic blood clotting index(CI) between observation group 1,2 and control group(P < 0.05). In terms of routine coagulation parameters, there were statistically significance differences between pregnant women and healthy women in prothrombin time(PT) and activated partial thrombin time(ATPP)(P < 0.05). Compared with observation group 1, except LY30, TEG test indexes of observation group 2 were significantly shortened(P < 0.05), there was no significant change in other indexes. In terms of the correlation between TEG and conventional coagulation parameters in pregnant women, except for α angle, the parameter values of other indicators had a certain correlation with traditional coagulation parameters, and PT and MA were positively correlated. APTT was positively correlated with R and negatively correlated with MA and CI. The positive correlation between INR and LY30 was low. Plt was negatively correlated with K value and positively correlated with MA and CI value. TT was positively correlated with MA. Conclusion TEG can dynamically and comprehensively observe the maternal blood coagulation function, and correct the maternal blood coagulation function reasonably and effectively according to the indicators, which has important clinical significance for reducing the surgical risk.
引文
[1]唐浩,傅云峰,桂嵘.孕妇血栓弹力图正常值参考范围的建立[J].中国输血杂志,2017,30(7):687-689.
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[3]杨丽萍,孔淑伟.分析血栓弹力图在早期诊断营养不良患者凝血功能障碍中的作用[J].新疆医学,2016,46(12):1549-1550.
[4]王燕.血栓弹力图在产后出血中的临床应用[J].中国社区医师,2017,33(19):129-130.
[5]Fu H,Zhang Y.Evaluation of platelet function in critically ill patients and its clinical significance[J].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue,2018,30(3):284-288.
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[8]朱洁,张玉泉.妊娠期凝血功能及血栓弹力图指标变化的研究进展[J].中国妇幼保健,2017,32(1):200-204.
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[11]堵敏霞,上官志敏,华晓莹,等.血栓弹力图在冠心病患者抗血小板治疗中的临床应用[J].国际检验医学杂志,2017,38(16):2322-2324.
[12]Kalkwarf KJ,Cotton BA.Resuscitation for Hypovolemic Shock[J].The Surgical clinics of North America,2017,97(6):1307-1321.
[13]Nates JL,Cattano D,Costa FS,et al.Thromboelastographic assessment of the impact of mexiletine on coagulation abnormalities induced by air or normal saline intravenous injections in conscious rats[J].Diving and hyperbaric medicine,2017,47(4):228-232.
[14]Fleming K,Redfern RE,March RL,et al.TEG-Directed Transfusion in Complex Cardiac Surgery:Impact on Blood Product Usage[J].J Extra Corpor Techno,2017,49(4):283-290.
[15]覃小矿,马曙轩,侯云生,等.血栓弹力图检测在指导心脏术后患儿成分输血中的应用价值[J].广西医学,2017,39(10):1521-1524.
[16]Kociszewska-Najman B,Szpotanska-Sikorska M,Mazanowska N,et al.The comparison of intelligence levels of children born to kidney or liver transplant women with children of healthy mothers[J].J Matern Fetal Neonatal Med,2018,1(23):3160-3165.
[17]Sun L,Zou G,Zhou F,et al.Outcome of dichorionic triamniotic triplet:the experience from an emerging fetal therapy center[J].J Matern Fetal Neonatal Med,2018,31(23):3075-3079.
[18]李晓英,侯允天.危重患者血栓弹力图与常规凝血指标的对比研究[J].中华老年多器官疾病杂志,2017,16(7):503-507.
[19]Escobar MF,Carvajal JA,Nieto AJ,et al.Model of obstetric attention based on critical care in Latin America[J].J Matern Fetal Neonatal Med,2018,31(23):3139-3146.
[20]Petousis S,Margioula-Siarkou C,Mamopoulos A,et al.Does first-trimester nuchal cord affect the blood flow in the ductus venosus?A prospective observational study[J].J Matern Fetal Neonatal Med,2018,31(23):3115-3118.
[2]易思华,林婧,罗强军,等.健康成人血栓弹力图参考范围的确立[J].西部医学,2016,28(2):266-269.
[3]杨丽萍,孔淑伟.分析血栓弹力图在早期诊断营养不良患者凝血功能障碍中的作用[J].新疆医学,2016,46(12):1549-1550.
[4]王燕.血栓弹力图在产后出血中的临床应用[J].中国社区医师,2017,33(19):129-130.
[5]Fu H,Zhang Y.Evaluation of platelet function in critically ill patients and its clinical significance[J].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue,2018,30(3):284-288.
[6]Laursen TH,Meyer MAS,Meyer ASP,et al.Thrombelastography early amplitudes in bleeding and coagulopathic trauma patients:Results from a multicenter study[J].JTrauma Acute Care,2018,84(2):334-341.
[7]Iitani Y,Tsuda H,Ito Y,et al.Simulation training is useful for shortening the decision-to-delivery interval in cases of emergent cesarean section[J].J Matern-fetal Neo M,2018,31(23):3128-3132.
[8]朱洁,张玉泉.妊娠期凝血功能及血栓弹力图指标变化的研究进展[J].中国妇幼保健,2017,32(1):200-204.
[9]Nielsen VG,Frank N,Matika RW.Carbon monoxide inhibits hemotoxic activity of Elapidae venoms:potential role of heme[J].Biometals,2018,31(1):51-59.
[10]Stettler GR,Moore EE,Moore HB,et al.Platelet adenosine diphosphate receptor inhibition provides no advantage in predicting need for platelet transfusion or massive transfusion[J].Surgery,2017,162(6):1286-1294.
[11]堵敏霞,上官志敏,华晓莹,等.血栓弹力图在冠心病患者抗血小板治疗中的临床应用[J].国际检验医学杂志,2017,38(16):2322-2324.
[12]Kalkwarf KJ,Cotton BA.Resuscitation for Hypovolemic Shock[J].The Surgical clinics of North America,2017,97(6):1307-1321.
[13]Nates JL,Cattano D,Costa FS,et al.Thromboelastographic assessment of the impact of mexiletine on coagulation abnormalities induced by air or normal saline intravenous injections in conscious rats[J].Diving and hyperbaric medicine,2017,47(4):228-232.
[14]Fleming K,Redfern RE,March RL,et al.TEG-Directed Transfusion in Complex Cardiac Surgery:Impact on Blood Product Usage[J].J Extra Corpor Techno,2017,49(4):283-290.
[15]覃小矿,马曙轩,侯云生,等.血栓弹力图检测在指导心脏术后患儿成分输血中的应用价值[J].广西医学,2017,39(10):1521-1524.
[16]Kociszewska-Najman B,Szpotanska-Sikorska M,Mazanowska N,et al.The comparison of intelligence levels of children born to kidney or liver transplant women with children of healthy mothers[J].J Matern Fetal Neonatal Med,2018,1(23):3160-3165.
[17]Sun L,Zou G,Zhou F,et al.Outcome of dichorionic triamniotic triplet:the experience from an emerging fetal therapy center[J].J Matern Fetal Neonatal Med,2018,31(23):3075-3079.
[18]李晓英,侯允天.危重患者血栓弹力图与常规凝血指标的对比研究[J].中华老年多器官疾病杂志,2017,16(7):503-507.
[19]Escobar MF,Carvajal JA,Nieto AJ,et al.Model of obstetric attention based on critical care in Latin America[J].J Matern Fetal Neonatal Med,2018,31(23):3139-3146.
[20]Petousis S,Margioula-Siarkou C,Mamopoulos A,et al.Does first-trimester nuchal cord affect the blood flow in the ductus venosus?A prospective observational study[J].J Matern Fetal Neonatal Med,2018,31(23):3115-3118.
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