血栓弹力图检测在产后大出血产妇输血治疗中的应用效果

Application effect of thromboelastography detection in blood transfusion treatment of postpartum hemorrhage in parturients

目的探讨血栓弹力图检测在产后大出血产妇输血治疗中的应用效果。方法本研究为回顾性队列研究。回顾性分析2020年3月至2023年3月鹤壁市人民医院收治的86例产后大出血患者的临床资料,将行凝血功能检测指导输血治疗的43例设为对照组,行血栓弹力图检测指导输血治疗的43例设为观察组。比较两组血栓弹力图参数变化、凝血功能变化、血常规指标及血液制品用量。结果治疗后观察组凝血反应时间(R)、血凝块形成时间(K)值[(5.65±0.68)min、(2.39±0.32)min]短于对照组[(6.29±0.74)min、(2.88±0.34)min],血块形成速率(Angle角)、凝血纤溶指标(LY30)[(62.48±5.34)°、(4.12±0.49)%]高于对照组[(58.41±5.22)°、(3.32±0.44)%],血凝块最大振幅(MA)[(54.65±4.82)min]长于对照组[(50.41±4.43)min],差异有统计学意义(P<0.05);治疗后观察组凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)[(14.36±1.22)s、(32.41±3.21)s、(17.14±1.45)s]短于对照组[(16.02±1.24)s、(35.41±3.34)s、(19.05±1.49)s],纤维蛋白原(FIB)[(2.95±0.32)g/L]高于对照组[(2.62±0.29)g/L],差异有统计学意义(P<0.05);治疗后观察组血红蛋白(Hb)、血小板计数[(118.96±8.57)g/L、(150.41±9.32)×10^(9)/L]高于对照组[(112.41±8.13)g/L、(140.54±9.24)×10^(9)/L],差异有统计学意义(P<0.05);观察组红细胞悬液输注量、新鲜冰冻血浆使用量[(2.28±0.41)U、(608.95±52.33)ml]少于对照组[(3.48±0.46)U、(749.54±75.41)ml],差异有统计学意义(P<0.05)。结论血栓弹力图检测在产后大出血产妇输血治疗中具有较高应用价值,可使输血更具针对性,能更好改善患者凝血功能及血常规指标,减少血液制品用量,避免医疗资源浪费。

Objective To investigate the application effect of thromboelastography detection in blood transfusion treatment of postpartum hemorrhage in parturients.Methods This study was a retrospective cohort study conducted on the clinical data of 86 patients with postpartum hemorrhage admitted to People’s Hospital of Hebi from March 2020 to March 2023.Of them,43 patients who underwent coagulation function testing to guide blood transfusion treatment were assigned to the control group,and 43 patients who underwent thromboelastography testing to guide blood transfusion treatment were assigned to the observation group.The changes in thromboelastogram parameters,coagulation function,blood routine indicators,and differences in blood product dosage were compared between the two groups.Results After treatment,the reaction time and K time values of the observation group were(5.65±0.68)minutes and(2.39±0.32)minutes,which were shorter than the(6.29±0.74)minutes and(2.88±0.34)minutes of the control group(P<0.05).The K-Angle and lysis at 30 minutes(LY30)values of the observation group were(62.48±5.34)°and(4.12±0.49)%,which were higher than the(58.41±5.22)°and(3.32±0.44)%of the the control group(P<0.05).The maxium amplitude value of the observation group was(54.65±4.82)minutes,longer than the(50.41±4.43)minutes of the control group(P<0.05).After treatment,the prothrombin time,thrombin time,and activated partial thromboplastin time of the observation group were(14.36±1.22)s,(32.41±3.21)s,and(17.14±1.45)s,which were shorter than the(16.02±1.24)s,(35.41±3.34)s,(19.05±1.49)s of the control group(P<0.05);while the fibrinogen of the observation group was(2.95±0.32)g/L,higher than the(2.62±0.29)g/L of the control group(P<0.05).After treatment,the hemoglobin and platelet count of the observation group were(118.96±8.57)g/L,(150.41±9.32)×10^(9)/L,higher than the(112.41±8.13)g/L,(140.54±9.24)×10^(9)/L of the control group(P<0.05).The infusion volume of red blood cell suspension and the usage volume of fresh frozen plasma of the observation group were(2.28±0.41)U and(608.95±52.33)ml,lower than the(3.48±0.46)U and(749.54±75.41)ml of the control group(P<0.05).Conclusions Thromboelastography detection has high application value in the treatment of postpartum hemorrhage in parturients,which can make blood transfusion more targeted,improve patient coagulation function and blood routine indicators,reduce blood product consumption,and avoid medical resource waste.