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目的与正常晚期妊娠孕妇比较,分析晚期妊娠合并重度子痫前期患者血栓弹力图(TEG)特点,及其与凝血各项检查指标的相关性。方法选取本院2012年1月至2014年12月期间收治的诊断妊娠晚期合并重度子痫前期的35例患者,并采用同期收治的同意行TEG检测的正常晚期妊娠孕妇(43例)作为对照,2组患者除按照产科或重症医学科诊疗常规进行救治外,均在入院后、分娩前抽取肘正中静脉血,行血常规、肝肾功能、弥漫性血管内凝血(DIC)常规、TEG检查,比较2组各项化验结果及TEG中R、K、CI、α角、MA参数差异,分析TEG各项参数与凝血指标的相关性。结果 2组患者年龄等一般数据比较差异无统计学意义(P>0.05)。重度子痫前期患者较正常晚期妊娠患者TEG中R值增大(t=-3.144,P=0.002),α角变小(t=2.367,P=0.02),凝血综合指数(CI)负值增大(t=2.495,P=0.015);血常规中血小板水平下降(t=3.500,P=0.001),凝血酶凝结时间(TT)增大(F=-3.800,P<0.001),血清白蛋白水平下降(t=6.632,P<0.001),尿素氮水平升高(F=-2.333,P=0.026)。凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)同TEG各项参数之间无相关性;TT与R(r=0.290,P=0.010)、CI(r=-0.257,P=0.023)及α角(r=-0.243,P=0.032)相关;血小板水平与CI(r=0.383,P=0.001)、K(r=-0.409,P<0.001)、α角(r=0.375,P=0.001)及MA(r=0.512,P<0.001)显著相关。结论晚期妊娠合并重度子痫前期患者总体凝血功能较正常产妇呈现低凝趋势,传统凝血检查不能表现,需借助TEG进行协助鉴别。TT及血小板水平可作为判断凝血功能可能异常的初筛指标,如能早期干预,可能降低围产期出血及栓塞性疾病发生率。
Objective To compare the characteristics of thromboelastography (TEG) in late pregnancy with severe preeclampsia and its correlation with coagulation parameters in pregnant women of normal late pregnancy. Methods Totally 35 pregnant women with severe preeclampsia diagnosed in our hospital from January 2012 to December 2014 were enrolled in this study. Forty-three pregnant women with normal late pregnancy (43 cases) who agreed to undergo TEG examination during the same period were selected as controls. In addition to the treatment according to the obstetrics or critical care disciplines, the patients in the two groups were drawn elbow median venous blood before admission after delivery, and received blood routine, liver and renal function, diffuse intravascular coagulation (DIC) routine, TEG examination, The differences of R, K, CI, α-angle and MA parameters in two groups were compared, and the correlation between TEG parameters and coagulation index was analyzed. Results There was no significant difference in general data such as age between the two groups (P> 0.05). The R value of TEG in patients with severe preeclampsia (t = -3.144, P = 0.002) and α angle (t = 2.367, P = 0.02) (T = 3.595, P = 0.001), thrombin coagulation time (TT) increased (F = -3.800, P <0.001) and serum albumin (T = 6.632, P <0.001). The level of urea nitrogen increased (F = -2.333, P = 0.026). Prothrombin time (PT) and activated partial thromboplastin time (APTT) had no correlation with the parameters of TEG; TT and R (r = 0.290, P = 0.010) (R = -0.409, P <0.001), alpha (r = -0.303, P = 0.001), alpha (r = -0.243, P = 0.001) and MA (r = 0.512, P <0.001). Conclusion The overall coagulation function of patients with severe preeclampsia in late pregnancy shows a tendency of low coagulation compared with that of normal pregnant women. The traditional coagulation test can not be performed and TEG is needed to assist in the identification. TT and platelet levels can be used as a screening index to determine the possible abnormal coagulation function, such as early intervention, may reduce the incidence of perinatal bleeding and embolic disease.