血栓弹力图异常图形分析及临床意义  

Analysis of clinical significance on the special thromboelastograph graphics

作　　者：吴小利[1,2] 李健[2] 向代军[2] 王成彬[1] 

机构地区：[1]温州医学院检验医学院与生命科学学院,325035 [2]解放军总医院临床检验科

出　　处：《中华检验医学杂志》2013年第5期400-404,共5页Chinese Journal of Laboratory Medicine

摘　　要：目的分析血栓弹力图（TEG）异常图形，提高对TEG的分析识别能力，为临床提供有价值的TEG检测结果。方法本研究为回顾性研究。分析解放军总医院15430例TEG结果，利用反应时间（R）、凝血时间（K）、凝同角（Angle）、最大振幅（MA）、血凝块溶解百分比（EPL）、30min血凝块幅度减少速率（LY30）、凝血指数（CI）等参数对纤溶亢进组、肝素应用图形组、纤维蛋白二次激活组、血小板功能组、抗血小板药物监测组等进行分析。结果纤溶亢进组：原发性纤溶亢进组，参数EPL值19．3，LY30值19．3，CI值0．4；继发性纤溶亢进组，EPL值11．6，LY30值11．6，CI值3．2。肝素应用图形组：肝素测试（CKH）R值较普通测试（CK）缩短组，CKH的R值10．9min，CK的R值50．8min；CKH的R值较CK延长组，CK的R值12．2min，CKH的R值15．7min。纤维蛋白二次激活图形组：真性功能性纤维蛋白二次激活组，首次检测最大振幅MA值35．2，更换通道复测MA值34．7；似性纤维蛋向二次激活组，首次检测MA值73．4，更换通道复测MA值20．0。血小板功能组：血小板功能减低组MA值21．6；血小板功能亢进组MA值79．2。抗血小板药物嗌测组：二磷酸腺苷（ADP）类抑制剂无效组（代表药物氯吡格雷），ADP抑制率10．9％；花生四烯酸（AA）代谢途轮抑制剂无效组（代表药物阿司肛林），AA抑制牢7．5％。结论对血栓弹力图异常图形的正确判断，能确保结果的准确性．减少人为不良事件的发生。Objective Through the analysis of the special thromboelastography （TEG） graphics to improve the ability of analysis and identification the TEG and provide more valuable results for clinical practice. Methods This study is a retrospective study. Retrospectively awalysis of 15 430 cases of TEG results fi＇om People＇s Liberation Army General Hospital, using the parametrs as reaction time （R）, the clotting time （K）, the solidification angle （Angle）, the maximum amplitude （MA）, the percentage of blood clot dissolution （EPL） , the rate of 30 minutes clot amplitudereduce （LY30）, the coagulation index （CI） and other parameters to analyze the hyperfibrinolysis group, the hepariu graphics group, the secondary activation of fibrin group, the platelet function group and the anti-platelet drug monitoring group. Results In the hyperfibrinolysis group, the EP1, value, I,Y30 value and CI value of primary hyperfibrinolysis group was 19. 3, 19. 3 and 0.4 respectively and the secondary hyperthyroidism group was 11.6, 11.6 and 3.2 respectively. In the heprin application graphic group, R value of CKH group was shorter than that of CK group （ 10. 9 vs. 50. 8） , R value of CKH group was longer than that of CK group （ 12.2 vs. 15.7）. In fiber protein secondary activation graphics groups, the MA value of the first time detection was 35.2, then replacing the channel repetition MA value was 34. 7 in true fnnctional fiber protein secondary activation group. For the pseudo fiber protein secondary activation group the first time detection MA value was 73.4, then replacing the channel repetitioq MA value was 20. 0. The MA value of platelet function reduce group and hypeffunction group was 21.6 and 79. 2 respectively in platelet function group. In anti-platelet drug monitoring group, the inhibition rate of adenosine diphosphate （ADP） of ADP inhil）itor （clopidogre]） ineffective group was 10. 9% ; And the inhibition rate of arachidonic acid （AA） of AA metabolic pathway inhibitor （aspirin�

关 键 词：血栓弹力描记术 判断 血液凝固 

分 类 号：R5[医药卫生—内科学]