弥漫性血管内凝血产妇围术期凝血与纤溶系统指标的检测及临床意义

Detection and Clinical Significance of Coagulation and Fibrinolysis System Indicators in Perioperative Period of Parturients with Diffuse Intravascular Coagulation

目的:探讨弥漫性血管内凝血(DIC)产妇围术期凝血与纤溶系统指标检测的临床意义。方法:选择2017年1到2017年12月在我院接受治疗的DIC孕妇57例(DIC组)为研究对象,采取分层抽样的方法选择同期在我院进行产检的正常孕妇57例(健康孕妇组)及在我院体检的健康非孕妇57例(非孕妇组)作为对照,比较各组凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)及血小板计数(PLT)变化,根据DIC组的治疗结果分为有效组和无效组,并比较两亚组治疗前PT、TT、APTT、FIB、D-D、PLT,采用Pearson相关分析法分析DIC组治疗前各检测指标间的相关性。结果:与健康孕妇组、非孕妇组比较,DIC组PT、TT、APTT延长(P<0.05),D-D水平升高(P<0.05),FIB、PLT水平降低(P<0.05);与非孕妇组比较,健康孕妇组PT、TT、APTT缩短(P<0.05),D-D水平降低(P<0.05),FIB、PLT水平升高(P<0.05)。DIC组患者治疗后有效组治疗前的PT、TT、APTT短于无效组(P<0.05),D-D水平低于无效组(P<0.05);FIB、PLT水平高于无效组(P<0.05)。Pearson相关分析结果显示,除PT与APTT之间无明显相关性(P>0.05)外,其他凝血、纤溶系统指标之间均存在一定的相关性(P<0.05)。结论:DIC孕妇围术期凝血与纤溶系统指标异常改变,检测凝血与纤溶系统指标对DIC孕妇的诊疗具有重要意义。

Objective:To explore the clinical significance of perioperative detection of coagulation and fibrinolysis system indicators in parturients with diffuse intravascular coagulation(DIC).Methods:The 57 DIC pregnant women(DIC group)who were treated in our hospital from January 2017 to December 2017 were selected as the research objects.57 normal pregnant women(healthy pregnant women group)and 57 healthy non-pregnant women(non-pregnant women group)who underwent maternity examination in our hospital during the same period were selected by stratified sampling method as the control group.The changes of prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-dimer(D-D)and platelet count(PLT)in each group were compared.According to the treatment results of DIC group,the patients were divided into effective group and ineffective group.The PT,TT,APTT,FIB,D-D and PLT of the two subgroups were compared before treatment.Pearson correlation analysis was used to analyze the correlation between the detection indicators before treatment in DIC group.Results:Compared with healthy pregnant women group and non-pregnant women group,the levels of PT,TT and APTT in DIC group prolonged(P<0.05),the level of D-D increased(P<0.05),the levels of FIB and PLT decreased(P<0.05).Compared with non-pregnant women group,the levels of PT,TT and APTT in healthy pregnant women group were shorter(P<0.05),the level of D-D decreased(P<0.05),the levels of FIB and PLT increased(P<0.05).The levels of PT,TT and APTT in the effective group before treatment were shorter than those in the ineffective group(P<0.05),the level of D-D was lower than that in the ineffective group(P<0.05).The levels of FIB and PLT were higher than those in the ineffective group(P<0.05).Pearson correlation analysis showed that there was no significant correlation between PT and APTT(P>0.05),but there was some correlation between other indicators of coagulation and fibrinolysis system(P<0.05).Conclusion:Perioperative abnormal changes of coagulation and fibrinolysis system indicators in pregnant women with DIC.Detection of coagulation and fibrinolysis system indicators is of great significance for the diagnosis and treatment of pregnant women with DIC.