超声检测联合血栓弹力图预测早期流产并指导抗凝治疗的临床价值  

Clinical value of ultrasonic testing combined with thromboelastography to predict early abortion and guide the anticoagulant therapy

作　　者：王菊 WANG Ju(Guangming District People's Hospital,Shenzhen 518106,China)

机构地区：[1]深圳市光明区人民医院,518106

出　　处：《中国实用医药》2024年第18期19-23,共5页China Practical Medicine

基　　金：2022年度光明区卫生系统科研项目(项目编号:gmws2022064)。

摘　　要：目的分析超声检测孕妇卵黄囊状态与基线血栓弹力图指标在评估不同妊娠结局与抗凝结局中的临床价值。方法收集215例孕妇,其中早期妊娠正常孕妇87例,作为A组;出现阴道流血、下腹部疼痛等早期流产症状的孕妇128例,根据妊娠结局不同分为B组(先兆流产妊娠结局良好,70例)和C组(先兆流产妊娠结局不良,58例)。经阴道超声对孕妇进行检查,记录卵黄囊直径、妊娠囊大小、胎芽长度及有无原始心管搏动等数据。对孕妇进行血栓弹力图凝血分析,记录反应时间(R)值、凝血时间(K)值、Angel角、最大振幅(MA)值、凝血综合系数(CI)值。比较三组超声检测卵黄囊情况(卵黄囊显示率、卵黄囊直径)、血栓弹力图基线资料,C组孕8~12、12~16周出现高凝状态孕妇治疗前后血栓弹力图指标变化情况。结果A组卵黄囊显示率为89.66%、B组为87.14%,均高于C组的55.17%,差异具有统计学意义(P<0.05);三组卵黄囊显示率比较差异有统计学意义(P<0.05)。A组、C组孕7~8、8~9、9~10、10~11、11~12周卵黄囊直径均大于B组,且A组小于C组,差异具有统计学意义(P<0.05);三组孕7~8、8~9、9~10、10~11、11~12周卵黄囊直径比较差异有统计学意义(P<0.05)。三组R值、K值、Angel角、MA值、CI值比较,差异有统计学意义(P<0.05)。C组R值、K值均低于A组、B组,Angel角、MA值、CI值均高于A组、B组,差异有统计学意义(P<0.05)。C组于孕8~12周出现高凝状态的孕妇25例,于孕12~16周出现高凝状态的孕妇28例。C组孕8~12周出现高凝状态孕妇治疗后R值、K值、Angel角、MA值、CI值分别为(7.31±0.45)min、(1.96±0.31)min、(75.78±7.21)°、(62.21±7.11)mm、(2.78±0.51),均优于治疗前的(5.79±0.51)min、(0.99±0.33)min、(86.29±6.21)°、(71.78±7.29)mm、(5.51±1.21),差异有统计学意义(P<0.05)。C组孕12~16周出现高凝状态孕妇治疗后R值、K值、Angel角、MA值、CI值分别为(7.01±0.44)min、(1.92±0.34)min�Objective To analyze the clinical value of ultrasonic detection of yolk sac status and baseline thromboelastography in evaluating different pregnancy outcomes and anticoagulation outcomes.Methods A total of 215 pregnant women were collected,of which 87 normal pregnant women with early pregnancy were selected as group A,128 pregnant women with early symptoms of abortion such as vaginal bleeding and lower abdominal pain were divided into group B(threatened abortion with good pregnancy outcome,70 cases)and group C(threatened abortion with poor pregnancy outcome,58 cases)according to the different pregnancy outcomes.The patients were examined by transvaginal ultrasound,and data such as the diameter of the yolk sac,the size of the gestational sac,the length of the fetal bud,and the presence or absence of primitive heart tube pulses were recorded.Thromboelastographic coagulation analysis was performed on pregnant women,and the reaction time(R)value,clotting time(K)value,Angel angle,maximum amplitude value,and clot index(CI)value were recorded.Comparison of ultrasound testing of yolk sacs(display rate of yolk sac,diameter of yolk sac),baseline data of thromboelastography among the three groups,and changes in thromboelastography indicators before and after the treatment of pregnant women with hypercoagulation at 8-12 and 12-16 weeks'gestation in group C.Results The display rate of yolk sac was 89.66%in group A,87.14%in group B,which was higher than 55.17%in group C,and the difference was statistically significant(P<0.05).There was significant difference in the display rate of yolk sac among the three groups(P<0.05).The yolk sac diameter of group A and group C was higher than that of group B at 7-8,8-9,9-10,10-11 and 11-12 weeks'gestation,and group A was smaller than group C.The difference was statistically significant(P<0.05).There were significant differences in yolk sac diameter among the three groups at 7-8,8-9,9-10,10-11 and 11-12 weeks'gestation(P<0.05).The R value,K value,Angel Angle,MA value and CI value of the th

关 键 词：超声检测 血栓弹力图 早期流产 卵黄囊 抗凝治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.21[医药卫生—诊断学]