摘要
目的探讨肝素酶杯血栓弹力图(hmTEG)对弥漫性血管内凝血(DIC)产妇肝素残留情况评估及合理用血的指导作用。方法选取30例足月妊娠DIC产妇(DIC组)和40例足月妊娠健康产妇(妊娠组),另选取50例健康体检女性(对照组),检测并比较3组患者血栓弹力图(TEG)结果,分析DIC组产妇在使用肝素治疗前凝血功能状态。根据DIC抗凝治疗肝素使用剂量,将DIC组患者分成微剂量组(16例)和中小剂量组(14例),检测并分析两组患者hmTEG结果,评估不同剂量肝素的残留情况以及对临床用血的指导作用。结果 3组患者TEG各指标差异有统计学意义(P<0.05)。DIC组患者与妊娠组、对照组比较,R值、K值升高(P<0.05),Angle角、MA值、CI值显著降低(P<0.05)。妊娠组与对照组比较,R值、K值显著降低(P<0.05),Angle角、MA值、CI值显著升高(P<0.05)。hmTEG结果显示,微剂量组与中小剂量组CK-TEG检测结果比较,R值、K值显著降低(P<0.05),Angle角、MA值、CI值显著升高(P<0.05)。微剂量组CKH-TEG与CK-TEG检测结果比较,R值、K值显著降低(P<0.05),Angle角、MA值、CI值显著升高(P<0.05),且R1>R2,提示肝素起效(未过量)。中小剂量组CKH-TEG与CK-TEG检测结果比较,R值、K值降低(P<0.05),Angle角、MA值、CI值显著升高(P<0.05),且R1≥2R2,提示肝素过量。微剂量组肝素残留率(6.25%)显著低于中小剂量组(71.43%)(P<0.05)。hmTEG指导血液成分用量与临床申请用血量比较,血浆、血小板、冷沉淀用量显著降低(P<0.05)。结论 hmTEG可用于评估产科DIC患者肝素抗凝治疗后是否存在肝素残留情况。产科DIC患者应用微剂量肝素抗凝治疗残留少,可减少临床血液用量。
Objective To investigate the application of heparinase modified thromboelastogram(hmTEG) in the assessment of heparin residual in puerpera with disseminated intravascular coagulation(DIC), so as to provide evidences for rational use of blood. Methods Thirty cases of full-term puerpera with DIC(DIC group) and 40 full-term healthy puerpera(pregnancy group) were collected. Another 50 healthy women(control group) were also selected. The TEG results of the three groups were compared. The clotting function status of the DIC group before treatment with heparin was analyzed. According to the dose of heparin treatment, the patients in the DIC group were divided into the micro-dose group(16 cases) and the medium-low dose group(14 cases). The hmTEG results of the two groups were assessed and analyzed, and the residual doses of heparin were also evaluated. Results The differences of TEG indexes among the three groups were statistically significant(P<0.05). Compared with the pregnant group and the control group, the R value and K value were significantly increased in the DIC group(P<0.05), and the Angle, MA value and CI value were significantly lower(P<0.05). Compared with the control group, the R and K values of the pregnant group were significantly lower(P<0.05), and the Angle, and MA and CI values were significantly increased(P<0.05). The results of hmTEG showed that the R and K values were significantly lower in the micro-dose group than in the low-dose group(P<0.05), and the Angle, MA and CI values were significantly increased(P<0.05). Compared with the results of CK-TEG and CK-TEG in the micro-dose group, the R and K values were significantly lower(P<0.05), while the Angle, MA value and CI value were significantly increased(P<0.05), and R1>R2, suggesting Heparin works(not in excess). Compared with the results of CK-TEG and CK-TEG in the low-dose group, the R and K values were decreased(P<0.05), the Angle, MA value, and CI value were significantly increased(P<0.05);with R1 lager than 2 R2, suggesting heparin. excess. The heparin residual rate(6.25%) in the micro-dose group was significantly lower than that in the medium-low dose group(P<0.05). The amount of blood components used in the guidance of hmTEG was significantly lower than that according to clinical experience;as the plasma, platelet, and cryoprecipitate applications were significantly lower(P<0.05). Conclusion The hmTEG can be used to evaluate the presence of heparin residues after heparin therapy in obstetric DIC patients. In puerpera with DIC, the use of micro-dose heparin anticoagulant therapy has fewer residues, which can reduce clinical blood consumption.
作者
曹倩
陆建福
钱磊
段倩倩
晁艳艳
CAO Qian;LU Jian-fu;QIAN Lei;DUAN Qian-qian;CHAO Yan-yan(Clinical Laboratory,Military Hospital of the Eighty-third Group of the Chinese People's Liberation Army,Xinxiang 453000,Henan,China)
出处
《广东医学》
CAS
2020年第1期82-85,共4页
Guangdong Medical Journal
关键词
肝素酶杯血栓弹力图
足月妊娠
弥散性血管内凝血
肝素
合理用血
heparinase modified thromboelastogram
term pregnancy
disseminated intravascular coagulation
heparin
rational use of blood
