晚期妊娠合并重度子痫前期患者血栓弹力图特点分析  

Characteristics of Thromboelastography in Patients with Advanced Pregnancy Complicated with Severe Preeclampsia

作　　者：贾佳[1] 杨巧妮[2] 赵子房 秦含玉 王秋实[2] 臧彬[1] JIA Jia YANG Qiaoni ZHAO Zifang QIN Hanyu WANG Qiushi ZANG Bin(Department of Critical Care Medicine, Shengjing Hospital, China Medical University, Shenyang 110004, China Department of Blood Transfusion, Shengjing Hospital, China Medical University, Shenyang 110004, China)

机构地区：[1]中国医科大学附属盛京医院重症医学科,沈阳110004 [2]中国医科大学附属盛京医院输血科,沈阳110004

出　　处：《中国医科大学学报》2016年第12期1105-1109,共5页Journal of China Medical University

基　　金：辽宁省自然科学基金(201102293);辽宁省省直医院改革重点科室临床诊疗能力建设项目(LNCCC-D13-2015)

摘　　要：目的与正常晚期妊娠孕妇比较,分析晚期妊娠合并重度子痫前期患者血栓弹力图(TEG)特点,及其与凝血各项检查指标的相关性。方法选取本院2012年1月至2014年12月期间收治的诊断妊娠晚期合并重度子痫前期的35例患者,并采用同期收治的同意行TEG检测的正常晚期妊娠孕妇(43例)作为对照,2组患者除按照产科或重症医学科诊疗常规进行救治外,均在入院后、分娩前抽取肘正中静脉血,行血常规、肝肾功能、弥漫性血管内凝血(DIC)常规、TEG检查,比较2组各项化验结果及TEG中R、K、CI、α角、MA参数差异,分析TEG各项参数与凝血指标的相关性。结果 2组患者年龄等一般数据比较差异无统计学意义(P>0.05)。重度子痫前期患者较正常晚期妊娠患者TEG中R值增大(t=-3.144,P=0.002),α角变小(t=2.367,P=0.02),凝血综合指数(CI)负值增大(t=2.495,P=0.015);血常规中血小板水平下降(t=3.500,P=0.001),凝血酶凝结时间(TT)增大(F=-3.800,P<0.001),血清白蛋白水平下降(t=6.632,P<0.001),尿素氮水平升高(F=-2.333,P=0.026)。凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)同TEG各项参数之间无相关性;TT与R(r=0.290,P=0.010)、CI(r=-0.257,P=0.023)及α角(r=-0.243,P=0.032)相关;血小板水平与CI(r=0.383,P=0.001)、K(r=-0.409,P<0.001)、α角(r=0.375,P=0.001)及MA(r=0.512,P<0.001)显著相关。结论晚期妊娠合并重度子痫前期患者总体凝血功能较正常产妇呈现低凝趋势,传统凝血检查不能表现,需借助TEG进行协助鉴别。TT及血小板水平可作为判断凝血功能可能异常的初筛指标,如能早期干预,可能降低围产期出血及栓塞性疾病发生率。Objective To analysis the characteristics of thromboelastography and coagulation test in patients with advanced pregnancy combined with severe preeclampsia. Methods A retrospective single-center study was conducted. 35 patients with advanced pregnancy combined with severe preeelampsia who were admitted to hospital from January 2012 to December 2014 were analyzed compared to 43 third trimester patients without any complication. All the patients were treated based on the routine strategy. Blood sample were taken from the middle elbow vein to test blood cell count, serum biochemistry test, routine coagulation test and thromboelastography. All the results, including R, K, CI, α-angle and MA value, were compared between two groups. Analysis was performed to evaluate the correlation between all parameters of TEG and coagulation test. Results There was no statistical significance between two groups in age, prothrombin time and activated partial prothrombin time. In the severe preeclampsia group, the R value of TEG was increased （ 5.21 ± 1.20 min vs 6.19- 1.55 min, t =-3.144, P = 0.002 ）, α-angel was decreased （ 64.43°± 7.90° vs 60.37°±7.09°, t =2.367, P = 0.02）, and CI was decreased （0.81±2.27 vs -0.37±1.82, t =2.495, P = 0.015 ）. In blood cell count test, the platelets count was decreased in severe preeclampsia group [ （217.48±65.68）×10^9/L vs （166.65±61.39） ×10^9/L, t =3.500, P = 0.001 ]. In routine coagulation test, only thrombin clotting time was increased in severe preeclampsia group （ 14.59±0.51 s vs 15.28±0.97 s, F =-3.800, P 〈 0.001 ）. In serum biochemistry test, the albumin was decreased in severe preeclampsia group （34.75±3.90 g/L vs 28.77±4.05 g/L, t =6.632, P 〈 0.001 ）,while serum urea nitrogen was increased （2.78±0.87 mmol/L vs 5.98±8.07 mmol/L, F =-2.333, P = 0.026）. In correlation analysis, thrombin clotring time had relationship between R （r =0.290, P = 0.010）, CI （r =-0.257, P = 0.023 ） and α-angle （r =-0.243, P = 0.032）. Platelets co

关 键 词：血栓弹力图 重度子痫前期 晚期妊娠 凝血功能 

分 类 号：R714.7[医药卫生—妇产科学]