用血栓弹力图评价肝素浓度变化对凝血系统的影响

目的通过血栓弹力图(thrombelastograph,TEG)研究不同肝素浓度下凝血系统的变化。方法对60名健康志愿者行枸橼酸真空抗凝管肘静脉抽血。用同种肝素钠注射液,使待测血样中肝素浓度分别为0、1、2、3、4、5、6 ku.L-1。用血栓弹力图测定凝血因子水平(reaction time,R)、纤维蛋白原时间(kinetics of clot development,K)、最大血块强度(maximum amplitude,MA)、凝血综合指数(coagulation index,CI)和最大血块形成时间(time to maximum amplitude,TMA),共5项参数。结果肝素浓度与凝血因子和血小板聚集功能的抑制程度成正比。当肝素浓度到达3 ku.L-1以上时,R和MA与对照组比较具有统计学意义。当肝素浓度到达4 ku.L-1以上时,R、MA、CI和TMA与对照组比较具有统计学意义。K值变化与肝素浓度变化无关。结论血栓弹力图可以全面检测肝素对血液的抗凝作用。研究认为,肝素可直接抑制凝血酶生成从而抑制凝血因子和血小板的促凝功能,使血液的综合凝血状态降低,血块形成时间延长。肝素用量多少和血液低凝状态存在线性关系,这对今后肝素使用、监测、出血风险等情况具有很好的临床预警价值。在管理肝素使用以及常规凝血风险管理中具有重要作用。

Evaluation of thrombelastography for the effect of heparin concentration changes on blood coagulation

Objective To study the clotting system in different concentrations heparin through thrombelastographic method.Methods The bloods of sixty healthy volunteers were phlebotomized in citric acid anticoagulation tube.The hepartin concentrations in test blood sample were 0,1,2,3,4,5,6 ku · L-1,respectively.Thrombelastographic method was used to determine R,K,MA,CI,TMA.Results Heparin concentration was in proportion to the inhibition effect of R and MA.When the heparin concentration was higher than 3 ku · L-1,R and MA had statistical significance compared with the control group.When the heparin concentration was higher than 4 ku · L-1,R,MA,CI and TMA had statistical significance compared with the control group.K was independent of heparin concentration.Conclusions Thrombelastography can fully detect the anticoagulant effects of heparin on blood.The research suggests that heparin can directly suppresses the formation of thrombin,thereby it can inhibiting coagulation factors and platelet procoagulant function.The blood clotting comprehensive state is reduced and blood clot formation time is extended by heparin.Dosage of heparin and low coagulability are linear relationship.The method has good clinical warning function for the future usage,monitor of heparin,bleeding risk and so on.It plays a very important role in the management of heparin usage and the control of bleeding risk.