血栓弹力图在初发急性心肌梗死患者中的临床应用  

Clinical application of thromboelastogram in patients with primary acute myocardial infarction

作　　者：张小乐[1] 蔡肇栩 张贺琼[1] 王洋洋[3] 陆少云[4] 杨春万[1] Zhang Xiaole;Cai Zhaoxu;Zhang Heqiong;Wang Yangyang;Lu Shaoyun;Yang Chunwan(CCU,Zhaoqing First People's Hospital,Zhaoqing 526000,China;Department of Pharmacy,Zhaoqing First People's Hospital,Zhaoqing 526000,China;Department of Blool Transfusion,Zhaoqing First People's Hospital,Zhaoqing 526000,China;Department of Emergency, Zhaoqing First People's Hospital, Zhaoqing 526000, China)

机构地区：[1]肇庆市第一人民医院CCU,广东肇庆526000 [2]肇庆市第一人民医院药学部,广东肇庆526000 [3]肇庆市第一人民医院输血科,广东肇庆526000 [4]肇庆市第一人民医院急诊科,广东肇庆526000

出　　处：《临床荟萃》2021年第2期125-128,共4页Clinical Focus

基　　金：肇庆市科技创新指导类项目血栓弹力图在初发急性心肌梗死患者的临床应用分析(202004030708)。

摘　　要：目的探讨血栓弹力图(thromboelastography,TEG)监测与急性心肌梗死患者的冠状动脉病变严重程度是否相关、与住院期间主要心血管不良事件(major adverse cardiac events,MACE)是否相关。方法选择我院初发急性心肌梗死(acute myocardial infarction,AMI)患者(AMI组)80例,健康体检者(正常对照组)30例。根据心电图表现,将AMI组分为急性ST段抬高型心肌梗死(ST elevated myocardial infarction,STEMI)组49例和非ST段抬高型心肌梗死(non ST elevated myocardial infarction,NSTEMI)组31例,在服用抗血小板药物和做急诊冠状动脉介入治疗术前的2小时内抽血监测血栓弹力图,比较两亚组血栓弹力图与冠状动脉病变程度Gensini评分、MACE的关系。结果AMI组R值和K值均低于正常对照组,且STEMI组R值和K值低于NSTEMI(P<0.05)。AMI组Angle和MA均高于正常对照组,且STEMI组Angle、MA值、Gensini评分和MACE发生率高于NSTEMI组(P<0.05)。结论AMI患者的高凝状态预示着更严重的冠状动脉病变、更高MACE发生率。Objective To analyze whether thromboelastogram(TEG)monitoring related to the severity of coronary artery pathological changes in patients with acute myocardial infarction(AMI)and whether it involved with cardiovascular adverse events in hospital.Methods Eighty patients with primary AMI were selected in our hospital as AMI group,30 healthy persons served as normal control group.According to electrocardiogram,AMI group was further divided into 49 cases of acute ST-elevated myocardial infarction(STEMI)group and 31 cases of non-ST-elevated myocardial infarction(NSTEMI)group.Thromboelastogram was monitored by blood drawing within 2 hours before taking antiplatelet drugs and undergoing emergency coronary intervention.The relationship between the thromboelastogram and coronary artery pathological changes degree Gensini score and major adverse cardiac events(MACE)were evaluated in two subgroups.Results The R value and K value of AMI patients were lower than those of normal control group.The R value and K value of STEMI group were lower than those of NSTEMI(P<0.05).The Angle and MA value of patients with AMI were higher than those of normal control group,and the angle,MA value,Gensini score and MACE incidence in STEMI group were higher than those in NSTEMI group(P<0.05).Conclusion Hypercoagulability in patients with AMI predicts more severe coronary artery pathological changes and a higher incidence of MACE.

关 键 词：心肌梗死 血栓形成 主要心脏不良事件 

分 类 号：R541.4[医药卫生—心血管疾病]