健康产妇经阴道分娩后血栓弹力图参考范围研究

Establishment of reference values for thromboelastography in healthy parturients after vaginal delivery

目的对健康产妇经阴道分娩后进行血栓弹力图(TEG)检测,建立参考范围,并与厂家提供的参考范围进行比较验证,分析TEG在产后的应用价值。方法2019年4—7月采集48例健康产妇经阴道分娩后d2的外周静脉血2 m L,用于血栓弹力图仪TEG(R、K、Angle、MA、LY30、EPL、CI、G)测定。结果48例健康产妇顺产后各参数平均值分别为R:2.74 min,K:1.18 min,Angle:73.37°,MA:63.47 mm,LY30:1.24%,EPL:1.24%,CI:3.32,G:8.49k d/sc。各参数95%可信区间分别为:R:2.61—2.87 min,K:1.12—1.24 min,Angle:72.50°—74.24°,MA:61.87—65.06mm,LY30:0.62%—1.85%,EPL:0.62%—1.85%,CI:3.06—3.58,G:7.64k—9.33k d/sc。首次顺产组与2次顺产组的各项TEG参数均无统计学差异。但与厂家提供的参考范围比较,产妇经阴道分娩后的R值偏低、Angle偏高、CI偏高。结论血栓弹力图检测可反映凝血因子、纤维蛋白原、血小板的功能及纤溶活性,不同人群所对应的参考范围也不一样。

Objective To determine the reference values for thromboelastography(TEG)in healthy parturients after vaginal delivery and compare them with those provided by the manufacturer.Meanwhile,the application value of TEG after delivery was analyzed.Methods A total of 48 healthy parturients were enrolled form April to July 2019.2 m L of peripheral venous blood was collected from each participant the next morning after vaginal delivery and TEG parameters(R,K,Angle,MA,LY30,EPL,CI and G)were measured.Results The mean values(95%CI)of TEG parameters for 48 healthy parturients were R:2.74 min(2.61—2.87 min),K:1.18 min(1.12—1.24 min),Angle:73.37°(72.50°—74.2°),MA:63.47 mm(61.87—65.06 mm),LY30:1.24%(0.62%—1.85%),EPL:1.24%(0.62%—1.85%),CI:3.32(3.06—3.58),G:8.49 k d/sc(7.64 k—9.33 k d/sc).There were no significant differences in TEG parameters between first natural labor group and secondary natural labor group.Compared with normal reference values provided by the manufacturer,the value of R was lower while the value of Angle and CI were higher in the healthy parturients after vaginal delivery.Conclusion The parameters of thromboelastography could reflect the activity of coagulation factor,fibrinogen,platelet and fibrinolysis.The reference values varies among different populations.