血栓弹力图用于经皮冠状动脉介入治疗术中肝素干预效果评估的临床研究

The application of TEG in evaluation of the intervention effect of heparin in percutaneous coronary intervention

目的研究血栓弹力图(TEG)用于经皮冠状动脉介入治疗(PCI)术中肝素干预效果评估的临床应用价值。方法选取该院择期行PCI术的120例患者作为研究对象,术前以普通肝素(UFH)静脉注射,分别在注射UFH后5min和30min检测活化凝血时间(ACT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及凝血酶时间(TT)等凝血功能相关指标,以及TEG反应时间(TEG-R)、血凝块形成时间等TEG相关指标,分析ACT和TEG-R与血小板聚集率的相关性,探讨TEG在PCI术中评估肝素干预效果的临床应用价值。结果注射UFH后5min血小板聚集率达标28例,ACT和TEG-R分别为(382.85±50.24)s和(58.57±10.25)min,未达标92例,ACT和TEG-R分别为(375.12±46.59)s和(52.23±7.38)min,两组ACT比较,差异无统计学意义(P>0.05),两组TEG-R比较,差异有统计学意义(P<0.05)。注射UFH后30min,血小板聚集率达标98例,未达标22例。达标组ACT和TEG-R分别为(355.56±40.51)s和(50.35±7.81)min,明显高于未达标组的(324.45±30.25)s和(42.78±4.24)min,差异均有统计学意义(P<0.05)。注射UFH后30 min患者ACT与血小板聚集率呈明显负相关(r=-0.936 4),TEG-R与患者血小板聚集率也呈明显负相关(r=-0.941 1)。结论 TEG较传统ACT监测用于PCI术中肝素干预效果评估能更准确反映患者凝血功能变化情况,对指导临床治疗,减少药物不良反应具有重要价值。

Objective To study the clinical value of thrombelastogram（TEG）applied in evaluation of the intervention effect of heparin in percutaneous coronary intervention（PCI）.Methods Totally 120 patients undergoing elective PCI in our hospital were included in the study.Before operation,all patients received intravenous injection of unfraction heparin（UFH）.At 5min and 30 min after injection of UFH,the activated clotting time（ACT）,prothrombin time（PT）,activated partial thromboplastin time（APTT）,thrombin time（TT）and other coagulation function related indicators,TEG reaction time（TEG-R）,blood clots formation time（K）,TEG-R and other TEG related indexes were detected.The correlation between ACT and TEG-R and platelet aggregation rate was analyzed.The clinical value of TEG applied in evaluation of the intervention effect of heparin in PCI was explored.Results At 5min after the injection of UFH,platelet aggregation rate reached the standard in 28 cases.ACT and TEG-R were（382.85±50.24）s and（58.57±10.25）min,respectively.Platelet aggregation rate did not reach the standard in 92 cases.ACT and TEG-R were（375.12±46.59）s and（52.23±7.38）min,respectively.The difference in ACT between the two groups was not statistically significant（P〉0.05）,while the difference in TEG-R was statistically significant（P〈0.05）.At 30 min after injection of UFH,platelet aggregation rate reached the standard in 98 cases and did not reach the standard in 22 cases.The ACT and TEG-R in standard group were（355.56±40.51）s and（50.35±7.81）min,significantly higher than the non standard group（324.45±30.25）s and（42.78±4.24）min,the difference was statistically significant（P〈0.05）.At 30 min after injection of UFH,there was significant negative correlations between ACT and platelet aggregation rate（r=-0.936 4）,between TEG-R and platelet aggregation rate（r=-0.941 1）.Conclusion Compared with the traditional ACT monitoring,TEG applied in evaluation of the intervention effect of heparin in PCI can more accurately reflect in the changes of blood coagulation function,which is of great value in guiding clinical treatment and reducing adverse drug reactions.