羊水栓塞患者sPLA2、PAF及凝血功能动态检测及临床意义

目的 探讨羊水栓塞患者动态检测凝血功能及血小板活化功能的临床意义.方法 选取羊水栓塞患者31例,检测栓塞前、栓塞后1 h及2 h凝血功能及血清血小板活化因子(PAF)及血清分泌型磷脂酶A2(sPLA2)水平,比较不同时间点及不同预后(死亡,存活)患者凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(T...

Clinical significance of dynamic detecting of PLA2, PAF and coagulation function in patients with amniotic fluid embolism

Objective To evaluate the clinical significance of dynamic detecting of coagulation and platelet activation in patients with amniotic fluid embolism. Methods Thirty cases with amniotic fluid embolism in our hospital from Jan 2016 to Jan2019 were selected. Coagulation function, platelet activating factor (PAF) and serum secretory phospholipase A2 (sPLA2) were measured before and 1 and 2 hours after embolization. Prothrombin time (PT) and activated partial thromboplastin time (APTT) of patients at different time points and with different prognosis were compared. Thrombin time (TT), fibrinogen (FIB), antithrombin Ⅲ(at Ⅲ), protein C (PC), protein S (PS), platelet activating factor (PAF) and serum secretory phospholipase A2 (sPLA2) were also compared. Results Coagulation function and platelet activation indexes in patients with amniotic fluid embolization were significantly different among before embolization, 1h and 2h after embolization (P<0.05). PT, APTT and TT were significantly higher 1 h after embolization than before embolization (P<0.05). FIB, AT Ⅲ, PC and PS were significantly lower 2 h after embolization than before embolization (P<0.05). FIB, AT Ⅲ, PC and PS were significantly lower 2 h after embolization than 1 h after embolization (P<0.05). PAF and sPLA2 were significantly higher 1 h after embolization than before embolization (P<0.05). PAF and sPLA2 were significantly higher 2 h after embolization than 1 h after embolization (P<0.05). Intergroup differences, time differences and interactions of coagulation function and platelet activation indexes in patients with different prognosis of amniotic fluid embolization had statistical significance (P<0.05). PT, APTT, TT, FIB, AT Ⅲ, PC, PS, PAF and sPLA2 were significantly higher in the dead patients than alive patients (P<0.05). The individual effects of time factors on the indicators of coagulation function and platelet activation were statistically significant between the two groups (P<0.05); and so were the differences among different time points in each group (P<0.05). ConclusionsWith the development of amniotic fluid embolism, coagulation dysfunction and platelet dysfunction continue to aggravate, which is correlated to prognosis. Dynamic monitoring of coagulation function and platelet activation function is helpful to evaluate the condition and prognosis.