血栓弹力图在急性脑梗死溶栓治疗中的应用

Application of thromboelastography in thrombolytic treatment of acute cerebral infarction

目的探讨血栓弹力图在急性脑梗死溶栓治疗过程中的临床意义。方法选取2018年6-9月天津市西青医院收治的68例急性脑梗死患者作为研究对象,入院时间窗内给予阿替普酶静脉溶栓治疗,在治疗前和之后的3、6 h获得5 ml血液样品,送至检验科行血栓弹力图检测。结果溶栓后3 h复查血栓弹力图,23例(33.82%)患者结果显示R值<5,立即加用舒洛地特抗凝治疗,12例(17.65%)患者显示MA值>70,则立即加用阿司匹林100 mg联合氯吡格雷75 mg治疗;溶栓后6 h复查血栓弹力图,21例(91.30%)患者结果显示R值恢复至正常范围内,2例(16.67%)患者MA值恢复至正常范围内,治疗后症状好转56例,有效率为82.35%;非症状性颅内出血患者1例,比例为1.47%。结论血栓弹力图可以用于监测静脉溶栓患者的凝血状态,并可以指导临床医生早期是否加用抗凝及抗血小板药物。

Objective To explore the clinical significance of thromboelastography in thrombolytic therapy of acute cerebral infarction.Methods Sixty-eight patients with acute cerebral infarction admitted to Tianjin Xiqing Hospital from June to September 2018 were selected as the study subjects.Intravenous thrombolysis with alteplase was given in the time window of admission to hospital.Blood samples of 5 ml were obtained before treatment and 3 and 6 hours after treatment and sent to the laboratory for thromboelastography.Results The thromboelastography was performed again 3 hours after thrombolysis.The results of 23 patients(33.82%)showed an R value of less than 5,and immediately treated with sulodexide anticoagulant therapy.Twelve patients(17.65%)showed that the MA value was greater than 70,and immediately treated with100 mg aspirin and 75 mg clopidogrel.The thromboelastogram was reviewed again 6 hours after thrombolysis.The results of 21 patients(91.30%)showed that the R value returned to the normal range,and 2 patients(16.67%)showed that the MA value returned to the normal range.After treatment,the symptoms improved in 56 cases,the effective rate was 82.35%;in 1 case of non-symptomatic intracranial hemorrhage,the proportion was 1.47%.Conclusion The thromboelastogram could be used to monitor the coagulation status of patients with intravenous thrombolysis,and could guide clinicians whether to add anticoagulant and antiplatelet drugs in the early stage.