高原地区患者术前凝血功能特征及血栓弹力图评估凝血功能的价值研究

Preoperative coagulation function of patients in plateau area and value of thrombelastography in assessment of coagulative function

目的探讨高原地区患者术前凝血功能特征及血栓弹力图评估凝血功能的价值。方法将青海红十字医院2015年1月-2016年1月收治的择期手术患者60例纳入研究,根据高原居住时间不同将所有入组患者分为长期在高原居住的观察组(n=30)、初到高原的对照组(n=30)。术前及术后3 h测定两组患者的凝血、血常规、血栓弹力图等指标,进一步分析血栓弹力图与凝血、血常规的相关性。结果观察组患者的术前及术后3 h的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)低于对照组,纤维蛋白原(FIB)、血小板(PLT)、血红蛋白(HGB)、红细胞比容(Hct)及红细胞(RBC)高于对照组(P<0.05);观察组患者的术前及术后3 h R值、CL30水平低于对照组,MA水平高于对照组(P<0.05);血栓弹力图中的R值、CL30与PT、APTT呈正相关,与FIB、PLT、HGB、Hct及RBC呈负相关(P<0.05),MA与PT、APTT呈负相关(P<0.05),与FIB、PLT、HGB、Hct、RBC呈正相关(P<0.05)。结论高原地区患者存在高凝状态,血栓弹力图可以直观评估患者的凝血功能及血常规状态,可用于临床凝血状态监测及早期采取干预措施,具有积极的临床意义。

Objective To analyze the preoperative coagulation function of patients in plateau area and value of thrombelastography in coagulation function assessment. Methods This study included 60 patients treated in Qinghai Red Cross Hospital between January 2015 and January 2016. According to different residence time in plateau area the patients were divided into long-term residence observation group （30 cases） and new-comer control group （30 cases）. Blood coagulation indexes, blood routine and thromboelastogram were measured . The relationships of thrombelastogram indexes with coagulation indexes and blood routine indexes were further analyzed. Results PT and APTT values before operation and 3 h after operation in the observation group were lower than those in the control group, while FIB, PLT, HGB, Hct and RBC values were higher than those in the control group （P〈0.05）. R value and CL30 level before operation and 3 h after operation in the observation group were lower than those in the control group, while MA level was higher than that in the control group （P 〈0.05）. R value and INR in the thrombelastogram were positively correlated with PT and APTT, but negatively correlated with FIB, PLT, HGB, Hct and RBC levels （P〈0.05）. MA in the thrombelastogram was negatively correlated with PT and APTT, but positively correlated with FIB, PLT, HGB,Hct and RBC levels （P 〈 0.05）. Conclusions Hypercoagulative state exists in patients in plateau area. Thrombelastogram can visually assess the patient＇s coagulation status and blood routine, can be used in clinical monitoring of coagulation status and early clinical intervention, thus has positive clinical significance.