血浆纤维蛋白原联合血栓弹力图预测高龄孕产妇剖宫产产后出血价值

Value of plasma fibrinogen expression level combined with thromboelastography for predicting postpartum hemorrhage of elderly pregnant women after cesarean section

目的:分析高龄剖宫产孕妇产前血浆纤维蛋白原(Fib)及血栓弹力图(TEG)参数对产后出血的预测价值.方法:选取2019年3月-2021年3月本院行剖宫产的高龄孕妇(年龄≥35岁)232例临床资料,依据产后出血情况分为非产后出血组(211例)和产后出血组(21例),检测产前凝血功能指标,包括凝血酶原时间(PT)、凝血酶时间(TT)、活化的部分凝血酶时间(APTT)、纤维蛋白原(Fib);TEG参数,包括凝血反应时间(R)、血凝块形成时间(K)、α角、最大振幅(MA)、凝血指数(CI).logistic回归分析高龄孕妇剖宫产产后出血影响因素.受试者工作特征曲线(ROC)分析血浆Fib联合TEG预测产后出血效能.结果:产后出血组产前Fib(2.74±0.38g/L)、MA值、CI值均低于非产后出血组(4.68±0.63g/L)(均P<0.05),两组产前PT、TT、APTT、R值、α角水平无差异(P>0.05).回归分析显示,产前Fib、MA值、CI值水平偏低,K值水平偏高是高龄孕产妇剖宫产发生产后出血的危险因素(P<0.05).产前Fib、K值、MA值、CI值预测高龄产妇剖宫产发生产后出血的曲线下面积(AUC)分别为0.909、0.813、0.794、0.816,各指标联合检测的AUC为0.943,敏感性96.7%、特异性93.3%,效能最高.结论:高龄孕妇产前血浆Fib及TEG水平与剖宫产产后出血有关且有一定预测价值,可为临床预防干预提供参考.

Objective: To detect the antenatal plasma fibrinogen(Fib) level and thromboelastography(TEG) parameters of elderly pregnant women before cesarean section, and to analyze their predictive value for the postpartum hemorrhage of the women. Methods: A total of 232 elderly pregnant women(age ≥35 years old) who underwent cesarean section were selected as the research objects from March 2019 to March 2021. According to the definition of postpartum hemorrhage, these women were divided into group A(211 cases without postpartum hemorrhage) and group B(21 cases with postpartum hemorrhage). The levels of indexes of coagulation function, such as prothrombin time(PT), thrombin time(TT), activated partial thromboplastin time(APTT), and Fib, and the values of TEG parameters, such as coagulation reaction time(R), clot formation time(K), α angle, maximum amplitude(MA), and coagulation Index(CI), of the women in the two groups were detected. Logistic regression analysis was used to analyze the influencing factors of postpartum hemorrhage of the elderly pregnant women after cesarean section. Receiver operating characteristic(ROC) curve was used to analyze the efficacy of the plasma Fib level combined with TEG for predicting postpartum hemorrhage of the women after cesarean section. Results: The Fib level(2.74±0.38 g/L) of the women in group B was significantly lower than that(4.68±0.63 g/L) of the women in group A, and the values of MA and CI of the women in group B were significantly lower than those of the women in group A(all P<0.05). There were no significant differences in the values of PT,TT,APTT,R,andαangle of the women between the two groups(P>0.05).Regression analysis showed that the prenatal Fib level,and the values of MA and CI of the women were low,and the K value was high,which all were the risk factors of postpartum hemorrhage of the elderly pregnant women after cesarean section(P<0.05).The area under the curve(AUC)of the prenatal Fib level,and the values of K,M,A and CI for predicting postpartum hemorrhage of the women after cesarean section were 0.909,0.813,0.794,and0.816,respectively.The AUC,the sensitivity,and the specificity of the combination of the prenatal Fib level,and the values of K,M,A and CI for predicting postpartum hemorrhage of the women were 0.943,96.7%,and 93.3%,respectively,with the highest predictive efficiency.Conclusion:The prenatal plasma Fib level and TEG parameters of the elderly pregnant women after cesarean section are closely related to their postpartum hemorrhage,which have certain predictive value for the occurrence of postpartum hemorrhage,and can provide evidences for clinical prevention intervention.