血栓弹力图在指导晚孕期胎儿宫内发育迟缓抗凝治疗中的应用效果

Application efficacy of thrombus elastography for guiding anticoagulant therapy in late-pregnant intrauterine growth retardation

目的探讨血栓弹力图(TEG)在指导晚孕期胎儿宫内发育迟缓(IUGR)抗凝治疗中的应用效果。方法将120例IUGR孕妇(孕30～36周)随机分为研究组和对照组,每组60例。两组孕妇均给予营养支持及低分子肝素抗凝治疗,对照组、研究组分别根据胎儿生长情况、TEG监测结果调整抗凝方案。治疗前后比较两组的TEG指标及凝血功能指标,并比较两组的出血及输血情况、妊娠及新生儿结局。结果治疗后研究组凝血酶形成时间长于治疗前与对照组,且最大振幅、α角小于治疗前与对照组(P<0.05)。治疗前后两组的凝血功能指标比较,差异均无统计学意义(P>0.05)。与对照组比较,研究组失血量更少,新生儿出生体重更高,低体重儿的发生率更低(均P<0.05)。两组早产、新生儿窒息的发生率比较,差异均无统计学意义(均P>0.05)。结论对于晚孕期胎儿IUGR孕妇,TEG能准确评估凝血功能,能更好地指导抗凝治疗,从而改善妊娠及新生儿结局。

Objective To explore the application efficacy of thrombus elastography(TEG) for guiding anticoagulant therapy in late-pregnant intrauterine growth retardation(IUGR). Methods A total of 120 pregnant women(30-36 weeks′ gestation) with IUGR were randomly divided into research group and control group,with 60 cases in each group.Pregnant women in both groups received nutritional support and anticoagulant therapy with low-molecular-weight heparin.Adjustment of anticoagulant plan was conducted in the control group and research group according to fetal growth and TEG monitoring results,respectively.TEG indices and coagulation function indices were compared between the two groups before and after treatment,along with conditions of bleeding and blood transfusion,pregnant and neonatal outcomes. Results After treatment,the thrombin formation time in the research group was longer than that before treatment or in the control group,the maximum amplitude and α angle in the research group were smaller than the indices before treatment or in the control group(all P <0.05).Before and after treatment,there was no statistically significant difference in coagulation function indices between the two groups( P >0.05).Compared with the control group,the research group had less blood loss,elevated neonatal birth weight and decreased incidence rate of low-birth weight neonate (all P <0.05).There was no statistically significant difference in incidence rate of premature birth or neonatal asphyxia between the two groups(all P >0.05). Conclusion For pregnant women with late-pregnant IUGR,TEG can accurately assess coagulation function,and provide better guidance for anticoagulant therapy,thereby improving pregnant and neonatal outcomes.