血栓弹力图在心肌梗死患者经皮冠状动脉介入治疗后凝血监测中的应用  

Application Value of Thromboelastography in Coagulation Monitoring in Patients with Myocardial Infarction after Percutaneous Coronary Intervention

作　　者：涂晶晶 郑英 陈小鹏 韩栋 徐嘉愉 TU Jingjing;ZHENG Ying;CHEN Xiaopeng;HAN Dong;XU Jiayu(Department of Blood Transfusion,The Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China;Statistics Office,The Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China;Blood Laboratory of Nanhai Hospital Affiliated to Southern Medical University,Foshan,Guangdong 528200,China)

机构地区：[1]南方医科大学第三附属医院输血科,广州510630 [2]南方医科大学第三附属医院统计室,广州510630 [3]南方医科大学附属南海医院血液实验室,广东佛山528200

出　　处：《岭南心血管病杂志》2023年第1期26-29,40,共5页South China Journal of Cardiovascular Diseases

基　　金：广东省医学科学技术研究基金项目(项目编号:A2019304)。

摘　　要：目的 分析血栓弹力图在心肌梗死患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后凝血监测中的应用价值。方法 回顾性分析2018年1月至2020年12月南方医科大学第三附属医院收治的118例心肌梗死患者的临床资料,将采用药物溶栓治疗的59例患者作为对照组,将采用PCI治疗的59例患者作为观察组。对比两组患者的一般资料、血栓弹力图、常规凝血指标、不良事件发生率。结果 两组患者的年龄、性别、基础疾病比较,差异无统计学意义(P>0.05),具有可比性。治疗后,观察组患者的反应时间(R)、凝血时间(K)均高于对照组,α角(凝血块形成点-描记图最大曲线弧度作切线、水平线夹角)、血块强度(MA)、LY30(MA确定后0.5 h血凝块溶解剩余的百分比)水平均低于对照组,差异有统计学意义(P<0.05)。治疗期间观察组患者不良事件发生率为1.69%,低于对照组的8.47%,但组间差异无统计学意义(P>0.05)。治疗后,观察组患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)、抗凝血酶原Ⅲ(AT-Ⅲ)浓度均高于对照组,差异有统计学意义(P<0.05)。结论 心肌梗死患者PCI治疗后凝血监测应用血栓弹力图,可有效评估临床效果,降低不良事件的发生风险。Objectives To analyze the application value of thromboelastography in coagulation monitoring in patients with myocardial infarction after percutaneous coronary intervention(PCI).Methods The clinical data of 118 patients with myocardial infarction treated from January 2018 to December 2020 in The Third Affiliated Hospital of Southern Medical University were retrospectively analyzed.The 59 patients treated with drug thrombolysis were in control group and 59 patients treated with percutaneous coronary intervention were in observation group.The general data,thromboelastogram,routine coagulation indexes and the incidence of adverse events were compared between the two groups.Results The age,sex and basic diseases of the two groups had no significant differences(P>0.05).After treatment,the reaction time(R)and coagulation time(k)in observation group were higher than those in control group,αangle(the tangent line of the maximum curve radian of clot formation point tracing diagram and the included angle of horizontal line),clot intensity(MA)and ly30(the percentage of clot dissolution remaining 0.5 h after MA determination)were lower than those in control group(P<0.05).During the treatment,the incidence of adverse events in observation group was 1.69%,lower than 8.47%in control group,but there was no significant difference between the two groups(P>0.05).After treatment,prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FBG)and antithrombinⅢ(at-Ⅲ)in observation group were higher than those in control group(P<0.05).Conclusions Thromboelastography can effectively evaluate the clinical effect and reduce the risk of adverse events in patients with myocardial infarction.

关 键 词：心肌梗死 血栓弹力图 血管成形术 经皮 经腔冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]