TEG指导新生儿凝血功能障碍诊治过程中的临床研究

Clinical study of thromboelastography in the diagnosis and treatment of neonatal coagulation dysfunction

目的探讨血栓弹力图(TEG)在指导新生儿凝血功能障碍诊治过程中的临床应用价值,为指导临床更合理地运用血浆制品提供理论依据。方法选取2018年1-12月在该院新生儿科住院的凝血功能障碍患儿115例为研究对象,均达到临床干预标准,随机分为研究组(TEG指导输血)和对照组(常规凝血检测指导输血)。对研究组TEG参数与凝血常规检测指标进行Pearson相关性分析,并对两组临床申请血浆制品成分、输注量以及临床疗效进行比较。结果研究组TEG参数R与凝血酶原时间(PT)、活化部分凝血酶时间(APTT)呈显著正相关关系;K与纤维蛋白原(FIB)和血小板计数(PLT)呈负相关关系;α角与FIB和PLT呈显著正相关关系;MA与FIB和PLT呈显著正相关关系。研究组冰冻血浆使用量明显比对照组降低,差异有统计学意义(P<0.05),血小板使用量变化不大。研究组患儿的肝素使用天数和住院天数均减少,差异有统计学意义(P<0.05),但治愈率与对照组比较,差异无统计学意义(P>0.05)。结论TEG参数与常规凝血项指标显著相关,两者结合能更准确地评估患儿的凝血功能;TEG在指导新生儿凝血功能障碍的诊治过程中具有指导意义。

Objective To explore the clinical application value of thromboelastography(TEG)in guiding the diagnosis and treatment of neonatal coagulation dysfunction,and to provide theoretical basis for guiding the clinical use of plasma products more rationally.Methods From January 2018 to December 2018,115 children with coagulation dysfunction were randomly divided into study group(TEG guided blood transfusion)and control group(routine coagulation test guided blood transfusion).Pearson correlation analysis was carried out between TEG parameters and coagulation routine test indexes in the study group,and the components of plasma products,infusion volume and clinical efficacy of the two groups were compared.Results In the study group,TEG parameter R positively correlated with prothrombin time(PT)and activated partial thrombin time(APTT).K negatively correlated with fibrinogen(FIB)and platelet(PLT);angle positively correlated with FIB and PLT.Ma positively correlated with FIB and PLT.The use of frozen plasma in the study group was significantly lower than that in the control group(P<0.05).The days of heparin use and the days of hospitalization in the study group decreased,the difference was statistically significant(P<0.05),but there was no difference on the cure rate between the study group and the control group(P>0.05).Conclusion TEG parameters significantly related to conventional coagulation indicators.The combination of the two can more accurately assess the coagulation function of children.TEG has guiding significance in guiding the diagnosis and treatment of coagulation dysfunction in newborns.