血栓弹力图技术指导产后出血大量输血治疗及对临床预后的影响  

The value of thrombelastography for guiding massive transfusion in postpartum hemorrhage treatment and its influence on the clinical prognosis

作　　者：蒋晓颖 周密 席岚[1] 郭永平[1] JIANG Xiaoying;ZHOU Mi;XI Lan;GUO Yongping(Baoji Maternal and Child Health Care Hospital, Shanxi Province, 721000)

机构地区：[1]陕西省宝鸡市妇幼保健院,721000

出　　处：《中国计划生育学杂志》2020年第4期596-600,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨血栓弹力图(TEG)在产后出血(PPH)大量输血(MT)治疗中的指导价值及对临床预后的影响。方法:收集2016年1月-2018年6月本院产科收治的严重PPH患者47例,采用TEG检测凝血功能并指导MT治疗。观察TEG检测前后成分血输注情况、不同TEG参数下输血情况,统计临床预后。结果:TEG检测显示,PPH产妇存在血液低凝状态。在Angle角<53°、R值>10min、MA<37mm患者中,滤白红细胞悬液(LPRC)、病毒灭活冰冻血浆及冷沉淀用量明显增加(P<0.05)。根据TEG参数调整输血成分后,R值和K值明显缩短,MA值、Angle值和CI值纠正,凝血功能显著改善(P<0.05);47例产妇均抢救成功,无死亡病例。结论:TEG检测能够全面反映产妇的凝血状态,对PPH的MT治疗有一定指导意义,可能有助于改善临床预后。Objective:To investigate the value of thromboelastography(TEG)for guiding massive transfusion(MT)in postpartum hemorrhage(PPH)treatment,and to study its influence on clinical prognosis.Methods:47 puerpera with severe PPH were enrolled in this study from January 2016 to June 2018.TEG was used to detect coagulation function and guide MT treatment.The blood infusion before and after TEG detection and the blood transfusion based on different TEG parameters was observed.The clinical prognosis of puerpera was analyzed.Results:TEG detection showed that the patients with PPH had hypocoagulable state.In puerpera with Angle<53°,R value>10 min,and MA<37 mm,the amount of leukocyte suspension(LPRC),and the dosages of virus inactivated frozen plasma and cryoprecipitate had significantly increased(P<0.05).After adjusting the transfusion composition according to the TEG parameters,the R and K values had significantly shortened,the MA value,Angle value and CI value had been corrected,and the coagulation function had been improved significantly(P<0.05).These 47 puerpera had been successfully rescued without death.Conclusion:TEG detection can fully reflect the coagulation status of patients,and it has certain guiding significance for MT in the treatment of PPH,which may help to improve the clinical prognosis.

关 键 词：产后出血 大量输血 血栓弹力图 指导价值 临床预后 

分 类 号：R714.461[医药卫生—妇产科学]