血栓弹力图在异位妊娠大出血中的应用

Application of thromboelastography in the treatment of hemorrhage due to ectopic pregnancy

目的:探讨血栓弹力图在异位妊娠大出血中的应用效果。方法:选取异位妊娠大出血患者100例(病灶组),其中在血栓弹力图指导下接受治疗的患者63例,为A组,未进行血栓弹力图指导接受治疗的患者37例,为B组;并选取体检正常的健康人50例为对照组。对两组患者的血常规检测结果和凝血功能指标和血栓弹力图各指标水平存在的差异进行研究。结果:病灶组血红蛋白(HGB)、红细胞计数(RBC)、红细胞压积(HCT)及血小板计数(PLT)均明显低于对照组(P<0.05);治疗后A组HGB、RBC、HCT及PLT均明显高于B组(P<0.05);病灶组凝血酶原时间(PT)、活化部分凝血酶时间(APTT)及凝血酶时间(TT)均明显高于对照组,纤维蛋白原(FIB)低于对照组,差异均有统计学意义(P<0.05);治疗后A组PT、APTT及TT均明显低于B组(P<0.05);A组患者在血栓弹力图指导下R值和K值均明显降低(P<0.01),而α角和血栓最大弹力度值则明显升高(P<0.01),凝血水平也明显提高。结论:血栓弹力图对异位妊娠大出血治疗的患者具有重要的指导意义。

Objective To discuss the therapeutic effects of thromboelastography on hemorrhage due to ectopic pregnancy.Methods Atotal of 100 patients with hemorrhage due to ectopic pregnancy were selected as focus group,including 63 patients treated with thromboelastography-guided therapy(group A)and 37 receiving treatment without the guidance of thromboelastography(group B),and 50 healthy subjects were selected as control group.The differences in the indexes of blood routine test,coagulation function and thromboelastogram were compared between the two groups.Results The hemoglobin,red cell counts,hematocrit and blood platelet count in focus group were significantly lower than those in control group(P<0.05).After treatment,the hemoglobin,red cell counts,hematocrit and blood platelet count in group A were significantly higher than those in group B(P<0.05).Compared with control group,focus group showed significantly longer prothrombin time,activated partial prothrombin time and thrombin time(all P<0.05),but had significantly lower level of fibrinogen,and the differences all had statistical significance(P<0.05).After treatment,the prothrombin time,activated partial prothrombin time and thrombin time in group A were significantly shorter than those in group B(P<0.05).For patients in group A receiving therapy with the guidance of thromboelastogram,the values of R and K were significantly decreased(P<0.01),whileα,the maximum thrombus elasticity and the level of blood coagulation factors were significantly increased(P<0.01).Conclusion Thromboelastography is of great significance in treating hemorrhage due to ectopic pregnancy.