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（TT）、纤维蛋白原（FIB）、抗血酶Ⅲ（ATⅢ）、蛋白C（PC）、蛋白S（PS）、血小板活化因子（PAF）及血清分泌型磷脂酶A2（sPLA2）水平。结果羊水栓塞患者栓塞前、栓塞后1 h、2 h凝血功能、血小板活化功能各指标差异均有统计学意义（P<0.05），FIB、ATⅢ、PC、PS低于栓塞前（P<0.05)。不同预后羊水栓塞患者凝血功能、血小板活化功能各指标组间差异、时间差异及交互作用均有统计学意义（P<0.05),FIB、ATⅢ、PC、PS低于存活患者(P<0.05)，PAF及sPLA2高于存活患者(P<0.05)。时间因素对两组患者凝血功能、血小板活化功能各指标的单独效应均差异有统计学意义（P<0.05），各组内两两时间点各指标差异均有统计学意义（P<0.05）。结论羊水栓塞患者随着病情进展，凝血功能障碍及血小板功紊乱持续加重，并与预后有关，动态监测凝血功能及血小板活化功能有助于评估病情及预后。

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.