血栓弹力图用于剖宫产术中凝血监测及预测出血量的临床研究

Clinical Study on Monitoring Obstetric Hemorrhage and Predicting the Bleeding Risk by Use of Thrombelastography

目的:评估血栓弹力图(TEG)在产科出血性疾病产妇剖宫产围术期凝血功能监测的价值,明确TEG能否预测剖宫产术中出血。方法:2015年11月至2016年3月并发有胎盘早剥、前置胎盘、胎盘植入或子痫前期等产科出血性疾病的择期剖宫产产妇30例为出血组,无上述并发症的择期剖宫产产妇30例为对照组,术中监测血常规、凝血象、TEG,判断TEG能否预测产科出血性疾病产妇剖宫产时术中出血量。结果:(1)两组产妇年龄差异无统计学意义;出血组产妇孕周明显小于对照组(P<0.05);出血组产妇术中平均出血量、术中平均输血量远大于对照组(P<0.05)。(2)出血组TEG参数K值与血红蛋白(Hb)、D-二聚体(D-D)正相关,与血小板(PLT)显著负相关(r=-0.575,P=0.003);MA、CI均与纤维蛋白原(Fig)正相关。对照组TEG参数R值、K值均与Hb正相关,与PLT负相关;MA、CI与Fig显著正相关;CI还与Hb负相关。(3)大出血(出血量>1000 ml)组产妇R值与PT显著正相关;K值与PLT、PT、Fig均显著相关。Angle角、MA与红细胞计数(RBC)、Hb、红细胞比容(HCT)、PLT、PT、活化部分凝血酶原时间(APTT)、Fig均分别显著相关;CI值与PT呈负相关,与Fig呈正相关。(4)TEG参数K值、Angle角、CI值均与出血量相关,以K值相关性最强。(5)出血组中大出血与未发生大出血的产妇各TEG参数均无明显差异。结论:出血组产妇TEG参数与血常规检查及凝血象检查有一定相关性,K值、Angle角、CI值与术中出血量相关,但无法预测此类产妇剖宫产术中是否发生大出血。

Objective：To evaluate the value of thrombelastography（TEG） in monitoring the coagulation func- tion during perioperative period in patients with hemorrhagic disease of obstetrics, and to study whether TEG can predict the total blood loss intraoperation. Methods：From November 2015 to March 2016,30 maternats with pla- cental abruption,placenta previa, placenta implantation or preeclampsia undergoing elective cesarean section as hemorrhage group（ group H）. 30 normal maternals without aforementioned complications as the control group （group C）. Monitoring the blood routine, coagulation,TEG intraoperative, determine whether TEG can predict the total blood loss in cesarean section perioperative period of maternal with obstetric hemorrhagic disease. Results： （1）There was no significant differences in maternal age between the two groups. Gestational age of group H was significantly less than the group C,the average total blood loss and the average transfusion of the group H were significantly higher than that in the group C. （2）In the group H, K value showed a positive correlation with hemoglo- bin（Hb） ,D-D,and a significant negative correlation with platelet（PLT） （r= -0. 575, P=0. 003） ;MA and CI also showed positive correlation with fibrinogen （Fig）. In the group C, R value and K value were positively correlated with Hb but negatively correlated with PLT ;MA,CI had obviously positive correlation with Fig, CI was also negatively correlated with Hb. （3）ln the maternal with blood loss 〉 1000 ml group, R value was significantly correlatedwith PT, K value was significantly correlated with PLT, PT and Fig. Angle and MA were significantly correlated with red blood cell count （ RBC）, Hb, hematocrit （ HCT）, PLT, PT, activated partial thromboplastin time （APTT） and Fig. CI was negatively correlated with PT but positively correlated with Fig. （4）The TEG parameter K value, Angle, CI were correlated with the total blood loss, K value had the strongest correlation. （5）There was no significant difference in the TEG parameters between the massive bleeding group and the non-massive bleeding group. Con- clusions：TEG parameters is proved to be associated with coagulation parameters, routine blood examination. The value of K,Angle and CI are related to the ammount of bleeding of maternal,which has hemorrhagic disease in cesarean section ,but can＇t predict the risk of massive hemorrhage.