AIS患者静脉溶栓过程中的血栓弹力图与凝血试验的比较

Application of thromboelastography and thrombotest in intravenous thrombolytic therapy of patients with acute ischemic stroke

目的观察急性缺血性脑梗死(AIS)患者瑞通立静脉溶栓过程中血栓弹力图(TEG)和凝血指标的变化。方法选取2013年10月至2015年8月在聊城市第三人民医院住院的AIS患者43例,从发病到溶栓治疗时间在4.5 h内,并在溶栓前及溶栓后0.5、1、2、4 h,采集其静脉血进行凝血和TEG分析。结果在瑞通立静脉溶栓过程中,TEG测定参数的凝血因子激活时间(R)、血块形成速率参数(K)、弹力图最大切角(α-Angle)、弹力图最大振幅(MA)和凝血指标均发生变化。溶栓后0.5 h活化部分凝血活酶时间(APTT)与溶栓前比较,差异有统计学意义(P<0.01),凝血酶原时间(PT)、凝血酶时间(TT)、D-二聚体(D-D)、纤维蛋白(原)降解产物(FDP)溶栓后2 h均达最高。溶栓后0.5 h R较溶栓前增高,溶栓后1 h达高值;K在溶栓后0.5 h达高值;α-Angle和MA在溶栓后0.5 h达低值;R、K溶栓后1 h与溶栓前比较,差异有统计学意义(P<0.01);α-Angle和MA溶栓后0.5 h分别与溶栓前比较,差异均有统计学意义(P<0.01)。结论在瑞通立静脉溶栓过程中TEG动态检测是判断凝血状态的有用工具。

Objective To observe the changes of thromboelastogram（TEG） and thrombotest in the thrombolysis process of acute ische- mic stroke（AIS） patients with reteplase. Methods Forty-three AIS patients hospitalized in the Third People＇s Hospital of Liaocheng City during October, 2013 to August, 2015 were enrolled. They experienced less than 4.5 hours of thrombolysis of reteplase after the onset of AIS. Their blood samples were obtained before reteplase administration and at 0.5, 1,2 and 4 hours after reteplase adminis- tration to perform TEG and thrombotest analysis. Results During the thrombolysis of reteplase, the parameters of TEG, such as reac- tion time（ R）, clotting time（ K）, coagulation angle（a-Angle） and maximal amplitude（ MA）, and thrombotest markers were changed. The activated partial thromboplastin time（APTT） at 0.5 hour after thrombolysis was significantly higher than that before thrombolysis （ P 〈 0.01 ）. The prothrombin time （ PT）, thrombin time （ TT）, D-dimer （ D-D ） and fibrin/fibrinogen degradation products （FDP） reached to the highest levels at 2 hours after thrombolysis. The R value increased at O. 5 hour after thrombolysis, and reached to the highest at 1 hour, significantly higher than that before thrombolysis（P 〈0. 01 ）. The K value reached to the highest at 0.5 hour after thrombolysis, significantly higher than that before thrombolysis（ P 〈 0.01 ）. The MA and coagulation angle reached to the lowest at 0. 5 hour after thrombolysis, significantly lower than that before thrombolysis （P 〈 0.01 ）. Conclusion During the thrombolysis of rete- plase, the dynamic determination of TEG is a useful tool for identifying the coagulation status of AIS patients.