围手术期患者血栓弹力图参数与血小板计数相关性分析

Investigation of Correlation between Parameters of Thrombelastogram and Platelet Count in Perioperative Patients

目的探讨围手术期患者不同水平血小板(PLT)与血栓弹力图(TEG)参数和常规凝血检测参数的相关性。方法选取2012年1月~2014年5月期间围手术期PLT减少症患者69例,PLT正常患者35例和PLT增高患者35例。分析其TEG参数[包括凝血反应时间(R),血细胞凝集成块时间(K),血细胞凝集成块速率(Angle),凝血块的最大强度(MA)]与常规凝血检测参数[包括凝血酶原时间(PT),活化部分凝血酶时间(APTT)和PLT计数]的相关性,以及不同水平PLT的患者PLT计数与上述指标的相关性。结果与PLT计数呈正相关的TEG参数有:MA(r=0.57,P<0.0001),Angle(r=0.54,P<0.000 1),CI(r=0.57,P<0.0001);R与PLT计数呈负相关(r=-0.27,P<0.000 1)。PLT计数与PT,APTT值无相关性。PLT轻度缺乏组[(87.34±10.43)×10~9/L]和正常组[(198.47±45.30)×10~9/L]PLT计数与MA(r=0.48,0.61,均P<0.01)和Angle呈正相关(r=0.53,0.51,均P<0.01),PLT重度降低组[(39.33±10.63)×10~9/L]和升高组[(330.34±35.43)×10~9/L]PLT计数与MA(r=0.26,0.15,均P>0.05)和Angle(r=0.20,0.24,均P>0.05)无相关性。结论正常和轻度PLT降低患者PLT计数与CI,Angle和MA呈显著正相关,与PT,APTT值无相关性;但在PLT中重度降低和PLT升高患者中,PLT计数与以上参数不相关,PLT中重度降低或者升高患者中PLT计数不能反应其聚集功能,MA更能敏感反应PLT功能。

Objective To investigate thrombelastogram（TEG）correlation between parameters and platelet count in perioperative period patients.Methods Selected 139 patients,69 cases with thrombocytopenia,35 cases with normal platelet number and 35 cases with thrombocytosis from 2012 January to 2014 May,monitored TEG,blood coagulation function and the change of blood routine during perioperative period.Spearman test was used to analyze the different level of platelet count and other coagulation parameters.Results The positive correlation between platelet count and TEG parameters were：MA（r=0.57,P〈0.57）,Angle（r=0.54,P〈0.000 1）,CI（r=0.57,P〈0.000 1）,and R was negatively correlated with platelet count（r=-0.27,P〈0.000 1）.There was no significant correlation between PT,APTT and platelet count.In mild lack of platelet group[（87.34±10.43）×10~9/L]and normal group [（198.47±45.30）×10~9/L],platelet count was positively correlated with MA and Angle.In severe lower[（39.33±10.63）×10~9/L]and higher group[（330.34±35.43）×10~9/L],there was no correlation between platelet platelet count with MA or Angle.Conclusion Platelet count was significantly correlated with CI,Angle and MA,but in patients with moderately severe lower platelet and platelet increase the platelet count do not reflect the aggregation function,MA is more sensitive response to platelet function.