血栓弹力图在围产期出血产妇输血中的指导作用

Guiding Role of Thromboelastography in Blood Transfusion of Perinatal Hemorrhage

目的:观察血栓弹力图(TEG)对围产期输血治疗出血产妇的作用。方法:选取2020年1月—2021年6月临沂市中心医院接受输血治疗的围产期出血产妇104例,随机数字表法分为对照组和观察组,各52例。对照组和观察组分别在常规凝血指标和TEG指导下进行输血。比较两组凝血功能、血液制品输注量及观察组输血前后TEG参数情况。结果:观察组输血后活化部分凝血活酶时间、血浆凝血酶原时间、凝血酶时间低于对照组,纤维蛋白原高于对照组,差异有统计学意义(P<0.01)。观察组新鲜冰冻血浆、冷沉淀、聚碳酸酯、鸡红细胞显著低于对照组,差异有统计学意义(P<0.01)。观察组输血后反应时间、凝固时间较输血前显著下降,最大振幅、凝血综合指数、凝固角、30 min血凝块幅度减少速率较输血前显著升高,差异有统计学意义(P<0.01)。结论:围产期出血产妇的输血治疗需格外慎重,其在该阶段凝血因子活性较高,应用TEG指导有助于医师及时了解患者凝血情况,针对性的调整血液制品输注,改善患者凝血状态,减少血液制品的浪费。

Objective:To observe the effect of thromboelastography(TEG)on perinatal blood transfusion in the treatment of perinatal Hemorrhage.Methods:A total of one hundred and four parturients with perinatal hemorrhage who received blood transfusion in Linyi Central Hospital from January 2020 to June 2021 were selected and divided into control group and observation group by random number table method,with fifty-two cases in each group.The control group and the observation group were transfused under the guidance of conventional coagulation index and TEG,respectively.Coagulation function,blood product infusion volume and TEG parameters before and after blood transfusion were compared between the two groups.Results:The activated partial thromboplastin time,plasma prothrombin time and thrombin time in the observation group were lower than those in the control group,and the fibrinogen time was higher than that in the control group,the difference was statistically significant(P<0.01);fresh frozen plasma,cryoprecipitate,polycarbonate and chicken red blood cells in the observation group were significantly lower than those in the control group,with statistical significance(P<0.01);the reaction time and coagulation time after transfusion in the observation group were significantly decreased compared with those before transfusion,while the reduction rate of maximum amplitude,coagulation index,coagulation angle and 30 min blood clot amplitude were significantly increased compared with those before transfusion,with statistical significance(P<0.01).Conclusion:The blood transfusion treatment of parturients with perinatal hemorrhage needs to be particularly careful,because the activity of clotting factors is high at this stage.The application of TEG guidance can help doctors to timely understand the clotting situation of patients,adjust the transfusion of blood products specifically,improve the coagulation status of patients,and reduce the waste of blood products.