深静脉血栓低分子肝素治疗中血栓弹力图和凝血指标分析的联合应用

目的 分析深静脉血栓(DVT)患者通过低分子肝素治疗过程中血栓弹力图(TEG)和凝血指标的变化。方法 对2017年1月～2018年1月期间武警海警总队医院58例深静脉血栓患者,经静脉采血后,测定溶栓前和溶栓后1,2,3和6 h的TEG和血凝指标,并进行统计学分析。结果 在溶栓过程中,TEG测定的反应时间(R)、凝固时间(K)、血细胞凝集块形成速率(a-Angle)、血凝块最大硬度(MA)和血凝指标都发生了变化。与溶栓前相比,溶栓后1 h R值增高,2 h达最高值。溶栓后1 h K值达最高值,溶栓后1 h a-Angle值、MA值均降低,TEG各参数在溶栓后3 h与溶栓前比较,差异有统计学意义(P<0.05)。溶栓后3 h凝血酶原时间(PT)、凝血酶时间(TT)和D-二聚体(DD)均达高值,溶栓后3 h纤维蛋白原(FIB)达最低。溶栓后2 h活化部分凝血活酶时间(APTT)达高值,血凝指标在溶栓后3 h与溶栓前比较,差异有统计学意义(P<0.05)。TEG各参数与血凝指标相关性分析,R值、K值分别与PT,APTT比较呈正相关,与FIB,DD比较呈负相关。a-Angle,MA分别与PT,APTT相比呈负相关,与FIB,DD比较呈正相关,差异均有统计学意义(P<0.05)。结论 TEG与血凝指标具有一定的相关性,联合检测更有助于深静脉血栓患者凝血功能的动态评估以及临床治疗。

Combined Application of Thrombelastogram and Coagulation Analysisin theTreatment of Deep Venous Thrombosis with Low Molecular Weight Heparin

Objective To analyze the changes of thrombelastogram(TEG)and coagulation index of patients with deep venous thrombosis(DVT)treated with low molecular weight heparin(LMWH).Methods Fifty-eight patients with deep veinous thrombosis treated with LMWH from January 2017 to January 2018 in Coast Guard Hospital of Armed Police in Jiaxing were selected.TEG and coagulation index in peripheral blood before and after thrombolysis treatment for 1,2,3 and 6 h were analyzed.Results During thrombolysis treatment,the reaction time(R),coagulation time(K),hemagglutination rate(a-Angle),maximum hardness of blood clot(MA)in TEG and coagulation index all changed.The R value increased at 1h and became the highest at 2h after thrombolysis treatment compared to that of before thrombolysis.After thrombolysis treatment,the K value reached to the highest at 1h.A-Angleand MA value decreased at 1h after thrombolysis.TEG parameters at 3h after thrombolysis treatment showed significant differences(P<0.05)compared to that of before thrombolysis treatment.The prothrombin time(PT),thrombin time(TT)and d-dimer(DD)increased,but the fibrinogen(FIB)reached the lowest at 3hafter thrombolysis treatment.Activation of partial thrombin time(APTT)becamethe highest at 2h after thrombolysis treatment.The coagulation index at 3h after thrombolysis showed significant differences(P<0.05)compared to that ofbefore thrombolysis treatment.Correlation analysis of TEG parameters and coagulation index showed that R value and K value were positively correlated with PT and APTT,and negatively correlated with FIB and DD.A-Angle and MA were negatively correlated with PT and APTT,and positively correlated with FIB and DD.Conclusion TEG was correlated with coagulation index,and combined analysis of TEG and coagulation index will be meaningful for the dynamic evaluation of coagulation and clinical treatment for patients with deep venous thrombosis.