血栓弹力图检测在急性心肌梗死患者中的应用研究

Study on the application of the value of Thrombus figure in patients with acute myocardial infarction

目的通过检测急性心肌梗死患者血栓弹力图的各项参数,并与常规凝血指标进行比较,并对其应用价值进行初步探讨。方法选取2016年1月~2016年12月在鄂尔多斯市中心医院心内科住院的98例急性心肌梗死患者(均在发病48 h内)作为研究对象,同期住院非心肌梗死患者20例作为对照组。应用TEG-5000血栓弹力图仪测定所有研究对象的R值、K值、Angle角、MA值;同时用Sysmex-cs5100全自动凝血分析仪对凝血功能(APTT、PT、FIb、TT)进行检测。结果急性心肌梗死组与对照组比较,常规凝血功能检测结果APTT、PT、TT值比较差异无统计学意义,FIb水平显著升高[(4.02±0.53)vs.(2.29±0.34)](P<0.05)。但在TEG检测结果中,急性心肌梗死患者与对照组相比,R值缩短[(5.28±1.06)vs.(8.05±1.23)];Angle角值增大[(70.62±3.90)vs.(60.23±3.41)];MA值升高[(64.05±3.42)vs.(56.21±2.38)]差异均具有统计学意义(P<0.05),但两组之间K值比较差异无统计学意义。结论血栓弹力图检测敏感性要高于常规凝血功能检测,可以动态监测凝血全过程,此方法可有效识别急性心肌梗死患者凝血功能的异常,对于临床医师早期判断心肌梗死患者凝血功能异常,指导早期预防和治疗提供了依据。

Objective To detect the parameters of the thrombus in patients with acute myocardial infarction(AMI),and to compare it with the conventional coagulation indexes.Methods98cases of acute myocardial infarction patients hospitalized in the department of Cardiology of Erdos Central Hospital(all within48h)from January2016to December2016as the object of study,patients with non myocardial infarction in20cases as control group.The R value,K value,Angle angle and MA value of all the subjects were measured by TEG-5000.The coagulation function(APTT,PT,FIb,TT)was detected by sysmex-cs5100Automatic Coagulation analyzer.Results Acute myocardial infarction group compared with the control group,routine coagulation test results of APTT,PT and TT decreased,but the difference was not statistically significant,FIb level increased significantly[(4.02±0.53)vs.(2.29±0.34)](P<0.05).But in the TEG test results in patients with acute myocardial infarction,compared with the control group,the R value is reduced by[(5.28±1.06)vs.(8.05±1.23)];Angle angle value increased[(70.62±3.90)vs.(60.23±3.41)];MA value increased[(64.05±3.42)vs.(56.21±2.38)]differences were statistically significant(P<0.05)between the two groups,but no significant difference in K value.Conclusion The sensitivity of thrombelastogram detection is higher than that of routine coagulation function test,and it can dynamicly monitor the whole process of blood coagulation,this method can effectively identify the abnormal blood coagulation function in patients with acute myocardial infarction,for clinicians to determine the early coagulation function in patients with acute myocardial infarction,provide the basis for early prevention and treatment guidelines.