妊娠相关血小板减少的凝血功能研究与输血策略  

Study on Coagulation Function and Transfusion Strategy of Pregnancy Associated Thrombocytopenia

作　　者：朱晓丽 陈艳飞 ZHU Xiao-li;CHEN Yan-fei(The Affiliated Taizhou People's Hospital of Nanjing Medical University,Taizhou Jiangsu 225300;The Affiliated Yancheng Maternal and Child Health Hospital of Yangzhou University,Yancheng Jiangsu 224001,China)

机构地区：[1]南京医科大学附属泰州人民医院,江苏泰州225300 [2]扬州大学附属盐城妇幼保健院,江苏盐城224001

出　　处：《泰州职业技术学院学报》2025年第1期67-71,96,共6页Journal of Taizhou Polytechnic College

摘　　要：目的分析妊娠相关血小板减少产妇围产期的凝血状态、输血策略、分娩方式、失血量,为治疗方案提供依据和输血指导、减少血资源浪费,优化分娩。方法回顾性分析2019年9月~2023年9月入住我院产科的妊娠相关血小板减少的71例孕妇和血小板正常的56例孕妇的血栓弹力图、常规凝血试验、血小板计数值、是否血小板输注、分娩方式的选择、术中失血量等。结果(1)按CI值分组,PT值低凝组与正常组比较P<0.05,差异有统计学意义,其余各组比较差异均无意义。(2)按MA值分组,PT值、APTT值和D-D值的血小板功能低下组与正常组比较P值均<0.05,差异有统计学意义;其余各项差异均无意义。(3)按血小板计数分组,重度血小板减少组分娩失血量与血小板轻度减少组和血小板正常组差异有统计学差异;血栓弹力图和出凝血各值之间两两比较差异无意义。(4)血小板计数与出凝血试验、血栓弹力图、分娩出血量各指标之间均无明显相关性。结论(1)TEG试验比传统血凝试验更能准确判断PAT产妇的凝血状态和血小板功能。(2)PLT<50×10^(9)/L时可预防性输注血小板,而50×10^(9)/L≤PLT<80×10^(9)/L时,可不输注血小板。(3)目前临床血小板输注的标准主要是以血小板计数为准,造成部分血小板资源的浪费。血小板计数很大程度上决定分娩方式选择。Objective To analyze the coagulation status,blood transfusion strategy,delivery mode,and blood loss of pregnant women with pregnancy-associated thrombocytopenia during the perinatal period,so as to provide basis for the treatment plan and blood transfusion guidance,reduce the waste of blood resources,and optimize delivery.Methods We retrospectively analyzed the data of thromboelastography,routine coagulation tests,platelet count,platelet transfusion,delivery mode,and intraoperative blood loss of 71 pregnant women with pregnancyrelated thrombocytopenia and 56 pregnant women with normal platelets who were admitted to the obstetrics department of our hospital from September,2019 to September,2023.Results(1)According to the grouping of CI value,the PT value of hypocoagulation group was compared with normal group(P<0.05),the difference was statistically significant,and the difference between the other groups was not significant.(2)When divided by MA value,PT value,APTT value and D-D value of the low platelet function group were compared with the normal platelet function group(P<0.05),the difference was statistically significant;The remaining differences were not significant.(3)Divided by platelet count,the blood loss in severe thrombocytopenia group was significantly different from that in mild thrombocytopenia group and normal group.There was no significant difference between the other values.(4)There was no significant correlation between platelet count and coagulation test,thromboelastography,and blood loss during delivery.Conclusions(1)TEG test is more accurate than traditional hemagglutination test in judging the coagulation status and platelet function of PAT parturients.(2)When PLT<50×10^(9)/L,platelets can be transfused prophylactically,while when 50×10^(9)/L≤PLT<80×10^(9)/L,platelets can not be transfused.(3)At present,the standard of clinical platelet transfusion is mainly based on platelet count,resulting in the waste of some platelet resources.The platelet count largely determines the mode of delivery

关 键 词：血栓弹力图 妊娠相关血小板减少 血小板计数 

分 类 号：R714.2[医药卫生—妇产科学]