血栓弹力图在产科妊娠晚期孕妇中的应用研究

Study on the Application of Thrombelastogram in Pregnant Women in the Third Trimester of Obstetrical Pregnancy

目的:分析血栓弹力图(TEG)在产科妊娠晚期孕妇中的应用价值。方法:选择笔者医院2019年7-12月收治的452例妊娠晚期孕妇,根据产后出血情况分为观察组(出血量≥500 ml)和对照组(出血量<500 ml),对比两组TEG参数(CI值、MA、α角、K、R)和常规凝血指标(TT、PT、APTT、Fib值)。结果:观察组产前CI值、MA值、α角均低于对照组,观察组K、R时间长于对照组,差异均有统计学意义(P<0.05)。观察组产前PT、APTT值均高于对照组,差异均有统计学意义(P<0.05),两组产前TT、FIB比较差异无统计学意义(P>0.05)。TEG预测产后大出血准确率(91.40%)、灵敏度(84.75%)均高于凝血四项(76.92%、67.79%),差异均有统计学意义(P<0.05)。结论:TEG指标能准确反映妊娠晚期孕妇凝血功能状态,预测产后出血准确率和灵敏度均高于常规凝血四项指标,能辅助评估妊娠晚期孕妇产后出血的风险,指导临床采取相应预防和治疗措施。

Objective:To analyze the application value of thrombelastogram(TEG)in obstetric pregnant women in the third trimester.Method:A total of 452 pregnant women in the third trimester from July to December 2019 in the author’s hospital were selected and were divided into the observation group(blood loss≥500 ml)and the control group(blood loss<500 ml)according to the postpartum hemorrhage.The TEG parameters(CI,MA,αAngle,K,R)and conventional coagulation parameters(TT,PT,APTT,Fib)were compared between the two groups.Result:The Antenatal CI value,MA value andαAngle in the observation group were all lower than those in the control group,K and R in the observation group were longer than those in the control group,the differences were statistically significant(P<0.05).The prenatal PT and APTT values in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05),while there were no statistically significant differences in the prenatal TT and FIB values of the two groups(P>0.05).The accuracy(91.40%)and sensitivity(84.75%)of TEG in predicting postpartum massive hemorrhage were higher than the four items of coagulation(76.92%and 67.79%),the differences were statistically significant(P<0.05).Conclusion:The TEG index can accurately reflect the coagulation function of pregnant women in the third trimester,and it is higher than the four indexes of conventional coagulation in predicting postpartum hemorrhage in accuracy and sensitivity.It can assist to evaluate the risk of postpartum hemorrhage in pregnant women in the third trimester,and guide clinical preventive and therapeutic measures.