血栓弹力图在评估剖宫产术后血栓形成风险中的应用

Application of Thromboela-stogram in Assessing the Risk of Thrombosis After Cesarean Section

目的探讨血栓弹力图在预测孕产妇剖宫产术后血栓形成风险中的意义。方法选取2016年1月—2017年10月我院产科剖宫产术后发生血栓栓塞患者24例作为病例组,选择同期在我院行剖宫产术未发生血栓栓塞性疾病的孕产妇24例作为对照组,对所有孕产妇行常规凝血指标和血栓弹力图检测,分析两组之间各参数的差异,并与血栓形成进行相关性分析。结果病例组与对照组凝血指标比较,两组孕妇DD、PT、NIR、APTT、PLT、R、Angle差异无统计学意义(P>0.05),FIB、TT、K、MA、CI差异有统计学意义(P<0.05)。对K、MA、CI与血栓风险的关系采用Pearson相关性分析,相关系数_rK=0.11,r_(MA)=0.66,r_(CI)=0.5,认为MA与血栓形成有强相关关系,CI与血栓形成有中等相关关系,K与血栓形成无相关关系。结论传统凝血指标中纤维蛋白原、D-二聚体及血小板均有不同程度的升高,但不能作为预测发生血栓风险的指标,需借助血栓弹力图进一步评估。MA值和CI值有望作为判断血栓形成高风险的初筛指标,如能早期干预,可能降低围产期血栓栓塞性疾病发生率。

Objective To explore the significance of thromboela-stogram in predicting the risk of thrombosis after cesarean section in pregnant in women. Methods 24 cases of thromboembolism after cesarean section in our hospital from January 2016 to October 2017 were selected as case group. 24 cases of cesarean section without thromboembolic disease in our hospital during the same period were selected as control group. Routine coagulation markers and thrombus elastograph were used for all pregnant women. The differences of the parameters between the two groups were analyzed, and the correlation analysis with thrombosis was made. ResultsThere was no statistically significant difference in DD, PT, NIR, APTT, PLT, R and Angle between the two groups of pregnant women（P〈 0.05）, but The differences of FIB, TT, K, MA and CI were statistically significant（P〈 0.05）. The relationship between K, MA and CI and thrombosis risk was analyzed by Pearson correlation analysis, correlation coefficient rK=0.11, rMA=0.66, rCI=0.5. It was considered that MA was strongly correlated with thrombosis, CI was correlated with thrombosis, K was not related to thrombosis. Conclusion Fibrinogen, D-two dimers and platelets increase in different degrees in traditional coagulation indicators, but they cannot be used as indicators for predicting thrombosis risk. Further evaluation is needed with thromboela-stogram. MA value and CI value judgment is expected as a high risk for thromboembolism screening indicators, such as early intervention may reduce the incidence of perinatal thromboembolic disease.