高危妊娠产后大出血产妇应用血栓弹力图参数指导输血治疗的临床效果

The clinical effect of blood transfusion in high risk pregnant women with postpartum massive hemorrhage guided by thrombologram parameters

目的探讨高危妊娠产后大出血产妇应用血栓弹力图(TEG)参数指导输血治疗的临床效果。方法选取2019年7月1日—2022年1月31日赣州市妇幼保健院妇产科接受输血治疗的108例产后大出血产妇为研究对象,所有产妇均需要紧急接受输血治疗,采用随机数字表将其分为TEG组和对照组,每组各54例,TEG组产妇根据TEG参数确定输血成分,对照组产妇则根据临床常规进行输血指导;对比两组产妇输血前后的凝血功能指标、TEG参数及产妇治疗转归。结果治疗前,TEG组和对照组产妇的凝血反应时间(R)、血凝块形成起始点至描记图最大曲线弧度做切线与水平线所成夹角(α角)、血凝块最大强度(MA)、血细胞凝聚成块时间(K)及凝血纤溶指标(LY30)测定值比较,差异均无统计学意义(均P>0.05);治疗后,TEG组产妇的R、K值[(5.68±0.61)min、(2.43±0.68)min]均低于对照组[(6.30±0.75)min、(2.80±0.75)min],TEG组产妇的α角、LY30测定值[(63.04±6.13)°、(4.11±0.89)%]均高于对照组[(59.42±5.86)°、(3.54±1.15)%],差异均有统计学意义(t=-4.713、-2.686、3.173及2.880,均P<0.05)。治疗前,TEG组和对照组产妇的凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶原时间(APTT)及纤维蛋白原(FIB)测定值比较,差异均无统计学意义(均P>0.05);治疗后,TEG组患者的APTT值低于对照组,差异有统计学意义(P<0.05),TEG组患者的FIB测定值高于对照组,差异有统计学意义(P<0.05)。治疗前,TEG组和对照组产妇的血红蛋白(Hb)、红细胞压积及血小板计数测定值比较,差异均无统计学意义(均P>0.05);治疗后,TEG组患者的血小板计数高于对照组,差异有统计学意义(P<0.05)。TEG组产妇的治愈出院率(98.15%)与对照组(96.30%)比较,差异无统计学意义(χ^(2)=0.343,P>0.05)。结论高危妊娠产后大出血产妇应用TEG参数指导输血能更有效、针对性纠正患者的凝血功能,值得在临床上推广应用。

Objective To investigate the clinical effect of thrombologram(TEG)parameters to guide blood transfusion treatment in high risk pregnant women with postpartum massive hemorrhage.Methods A total of 108 parturients with postpartum massive hemorrhage who received blood transfusion treatment in the Obstetrics and Gynecology Department of Ganzhou Maternal and Child Health Hospital from July 1,2019 to January 31,2022 were selected as the research objects.All parturients who needed urgent transfusion treatment were divided into TEG group and control group by random number table,with 54 cases in each group.TEG group parturients were determined according to TEG parameters,and control group parturients were transfused according to clinical routine guidance.The coagulation function indexes,TEG parameters and therapeutic outcomes of the two groups were compared before and after transfusion.Results Before the treatment,TEG and control group of maternal coagulation reaction time(R),the starting point of blood clot formation to the maximum curve radian of the tangent and horizontal line angle(αangle),the maximum strength of blood clot(MA),blood cell condensation time(K)and coagulation fibrinolysis index(LY 30)measurement value comparison,the differences were not statistically significant(all P>0.05).After treatment,the R and K values in the TEG group[(5.68±0.61)min,(2.43±0.68)min]were lower than those of the control group[(6.30±0.75)min,(2.80±0.75)min],αangle and LY 30 in TEG group[(63.04±6.13)°,(4.11±0.89)%]were all high dry control group[(59.42±5.86)°,(3.54±1.15)%],the differences were statistically significant(t=-4.713,-2.686,3.173 and 2.880,all P<0.05).Before the treatment,Comparison of prothrombin time(PT),thrombin time(TT),activated partial prothrombin time(APTT),fibrinogen(FIB)in TEG and control women,the differences were not statistically significant(all P>0.05).After treatment,the APTT value of TEG group was lower than that of control group,the difference was statistically significant(P<0.05),the FIB of TEG group was higher than that of control group,the difference was statistically significant(P<0.05).Before treatment,There were no significant differences in hemoglobin(Hb),hematocrit and platelet count between TEG group and control group(all P>0.05).After treatment,platelet counts in the TEG group were higher than those in the control group,with statistically significant differences(P<0.05).The discharge rate in the TEG group(98.15%)compared with the control group(96.30%),there was no statistically significant difference(χ^(2)=0.343,P>0.05).Conclusion The application of TEG parameters to guide blood transfusion can more effectively correct the coagulation function of patients with high risk pregnancy postpartum massive hemorrhage,and it is worthy of clinical application.