血栓弹力图在急性脑梗死尿激酶溶栓患者中的应用研究

Study on application of thromboelastography in acute cerebral infarction patients treated with urokinase thrombolysis

目的 探究血栓弹力图在急性脑梗死尿激酶溶栓患者救治中的应用价值。方法 选取50例急性脑梗死患者为研究组,另选取同期健康体检者50例为对照组。研究组予尿激酶静脉溶栓治疗,比较两组血栓弹力图指标[凝血反应时间(R)、凝血形成时间(K)、血凝块形成速率(Angle)、最大振幅(MA)、30 min血凝块幅度减少速率(LY30)]、凝血功能指标[凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D二聚体(D-D)、国际标准化比值(INR)]及血小板计数(PLT)。结果 研究组治疗前R值、K值、Angle值、MA值、LY30值、PLT、PT、APPT、TT、FIB、D-D、INR分别为(5.81±0.45)min、(2.17±0.28)min、(69.36±3.57)deg、(65.38±5.66)mm、(0.96±0.05)%、(244.06±17.64)×10^(9)/L、(10.08±1.27)s、(23.68±3.54)s、(14.06±1.37)s、(4.63±0.82)g/L、(0.36±0.03)mg/L、(0.62±0.38),治疗1 h后分别为(5.98±0.34)min、(2.26±0.15)min、(67.85±3.61)deg、(62.48±5.35)mm、(0.93±0.07)%、(237.06±17.39)×10^(9)/L、(11.24±1.68)s、(25.43±2.33)s、(15.24±1.22)s、(3.48±0.84)g/L、(0.32±0.05)mg/L、(0.79±0.47),治疗24 h后分别为(6.26±1.03)min、(2.58±0.44)min、(64.27±6.07)deg、(56.48±4.64)mm、(0.90±0.01)%、(218.06±25.47)×10^(9)/L、(12.39±1.07)s、(29.28±2.94)s、(17.11±1.56)s、(2.78±0.24)g/L、(0.26±0.05)mg/L、(0.92±0.61);对照组R值、K值、Angle值、MA值、LY30值、PLT、PT、APPT、TT、FIB、D-D、INR分别为(6.72±1.95)min、(2.75±0.52)min、(61.94±5.93)deg、(54.74±4.69)mm、(0.87±0.12)%、(214.06±26.48)×10^(9)/L、(13.18±1.35)s、(32.12±3.77)s、(18.04±0.64)s、(2.56±0.72)g/L、(0.24±0.04)mg/L、(1.18±0.62)。研究组治疗前、治疗1 h后,R值、K值均短于对照组,Angle值、MA值、LY30值、PLT均高于对照组,差异有统计学意义(P<0.05)。研究组治疗1、24 h后,R值、K值均显著长于本组治疗前,Angle值、MA值、LY30值、PLT均低于本组治疗前,差异均有统计学意义(P<0.05)。研究组治疗前、治疗1 h后、治疗24 h后,PT、TT、APPT均短于对照组,INR低于对照组,FIB、D-D高于对照组,差异有统计学意义(P<0.05)。研究组治疗1、24 h后,PT、TT、APPT均长于本组治疗前,INR高于本组治疗前,FIB、D-D低于本组治疗前,差异均有统计学意义(P<0.05)。结论 血栓弹力图应用于急性脑梗死尿激酶溶栓患者救治中可对凝血状态、药物治疗效果进行监测,具有较高的临床应用价值。

Objective To investigate the application effect of thromboelastography in acute cerebral infarction patients treated with urokinase thrombolysis.Methods 50 patients with acute cerebral infarction were selected as the research group,and another 50 healthy subjects from the same period in our hospital were selected as the control group.The research group received intravenous thrombolytic therapy with urokinase.Both groups were compared in terms of thromboelastography indexes [reaction time(R),clot formation time(K),rate of clot formation(Angle),maximum amplitude(MA),30 min clot amplitude reduction rate(LY30)],coagulation indexes [prothrombin time(PT),activated partial thromboplastin time(APTT),thromboplastin time(TT),fibrinogen(FIB),D-dimer(D-Dimer),international normalized ratio(INR)] and platelet count(PLT).Results Before treatment,the research group had R of(5.81±0.45) min,K of(2.17±0.28) min,Angle of(69.36±3.57) deg,MA of(65.38±5.66) mm,LY30 of(0.96±0.05)%,PLT of(244.06±17.64)×10^(9)/L,PT of(10.08±1.27) s,APPT of(23.68±3.54) s,TT of(14.06±1.37) s,FIB of(4.63±0.82) mm,D-D of(0.36±0.03) mg/L,and INR of(0.62±0.38);after 1 h of treatment,the research group had R of(5.98±0.34) min,K of(2.26±0.15) min,Angle of(67.85±3.61) deg,MA of(62.48±5.35) mm,LY30 of(0.93±0.07) %,PLT of(237.06±17.39)×10^(9)/L,PT of(11.24±1.68) s,APPT of(25.43±2.33) s,TT of(15.24±1.22) s,FIB of(3.48±0.84) mm,D-D of(0.32±0.05) mg/L,and INR of(0.79±0.47);after 24 h of treatment,the research group had R of(6.26±1.03) min,K of(2.58±0.44) min,Angle of(64.27±6.07) deg,MA of(56.48±4.64) mm,LY30 of(0.90±0.01)%,PLT of(218.06±25.47)×10^(9)/L,PT of(12.39±1.07) s,APPT of(29.28±2.94) s,TT of(17.11±1.56) s,FIB of(2.78±0.24) mm,D-D of(0.26±0.05) mg/L,and INR(0.92±0.61).The control group had R of(6.72±1.95) min,K of(2.75±0.52) min,Angle of(61.94±5.93) deg,MA of(54.74±4.69) mm,LY30 of(0.87±0.12)%,PLT of(214.06±26.48)×10^(9)/L,PT of(13.18±1.35) s,APPT of(32.12±3.77) s,TT of(18.04±0.64) s,FIB of(2.56±0.72) mm,D-D of(0.24±0.04) mg/L,and INR of(1.18±0.62).Before treatment and after 1 h of treatment,the R and K of the research group were shorter than those of the control group,and the Angle,MA,LY30 and PLT were higher than those of the control group,and the differences were statistically significant(P<0.05).The research group had significantly longer R and K after 1 and 24 h of treatment than those before treatment,and lower Angle,MA,LY30and PLT than those before treatment,and the differences were statistically significant(P<0.05).The research group had shorter PT,TT and APPT before treatment,after 1 and 24 h of treatment than those of the control group,lower INR than that of the control group,and higher FIB and D-D than those of the control group,and the differences were statistically significant(P<0.05).The research group had longer PT,TT and APPT after 1 and 24 h of treatment than those before treatment,higher INR than that before treatment,and lower FIB and D-D than those before treatment,and the differences were statistically significant(P<0.05).Conclusion The application of thromboelastography in acute cerebral infarction patients treated with urokinase thrombolysis can monitor the coagulation status and the effect of drug treatment,which has high clinical application value.