血栓弹力图在产科原发性纤溶症诊断中的应用——附报告1例

The application of thromboelastogram in a case of obstetric primary fibrinolysis

目的探讨血栓弹力图(TEG)检测在产后原发性纤溶亢进症诊断的应用。方法临床1例产后阴道持续出血患者,采集患者血样分别进行r-TEG(快速TEG检测)和传统凝血检测,将r-TEG检测和传统凝血检测结果进行分析。结果患者术后30min r-TEG检测结果 ACT 931s、R值9.4min、K值无法确定、Angle 7.8°、MA值9.3 mm、分别提示患者凝血因子,纤维蛋白原,血小板功能均低于正常;LY30 18%,活化部分凝血酶时间63.4 s,凝血酶原时间22.8 s,FDP 10μg/ml、D-dimer 0.2μg/ml,提示患者原发性纤溶亢进,依据TEG检测结果给予相应药物和血液制品对症治疗,患者术后3 h凝血功能逐渐恢复,出血停止;术后24 h复查TEG结果完全正常。结论血栓弹力图检测对产后原发性纤溶亢进患者的诊疗具有重要指导意义。

Objective To investigate the application of the thromboelastogram( TEG) for analyzing primary fibrinolysis in postpartum patients. Methods In one case of postpartum vaginal bleeding,blood samples were collected from the patient for r-TEG( rapid thromboelastogram) and conventional coagulation tests. The results of TEG and conventional coagulation tests were analyzed. Results Thirty minutes after surgery,the results from r-TEG exhibited the following: ACT 931,R value 9. 4min,unidentified K value,angle value 7. 8°,and MA value 9. 3mm. The level of blood coagulation factor,fibrinogen and platelet functions were lower than normal. The conventional coagulation results showed APTT 63. 4, PT 22. 8,FDP10μg / m L and D-dimer 0. 2μg / m L. These results inferred that the patient had primary fibrinolysis. The patient was then treated with medicine and blood products,according to the results provided by TEG. Three hours later,patient's coagulation function returned to normal,while bleeding was brought to an end. Conclusion This case suggested that the TEG played an important role for detecting primary fibrinolysis in postpartum patients.