摘要
目的探讨血栓弹力图联合凝血四项对产妇产后出血(PPH)风险的临床评估价值,旨在为产后出血防控提供循证依据。方法收集98例产妇为研究对象,按产后出血量大小分为A组(出血量<500 ml,n=77)和B组(出血量≥500 ml,n=21)。检测两组凝血四项指标,并进行血栓弹力图分析。比较两组凝血四项指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)、凝血酶时间(TT)];分析PT与产妇产后出血量的相关性;比较两组血栓弹力图指标[凝血反应时间(R)、血栓形成的最大幅度(MA)、凝血形成时间(K)、凝血块形成速率(Angle)、综合凝血指数(CI)];分析产后出血量与血栓弹力图指标的相关性;分析产妇APTT、PT对产后出血的预测效能。结果A组APTT(22.8±4.9)s、PT(10.5±2.1)s显著短于B组的(52.3±9.8)、(21.6±4.3)s,Fib(4.1±1.6)g/L显著高于B组的(0.9±0.5)g/L,有统计学差异(P<0.05);两组TT比较无统计学差异(P>0.05)。Pearson相关性分析结果显示:PT与产后出血量呈正相关(r=0.554,P<0.05)。A组R(6.8±3.9)min、K(-2.1±0.3)min均短于B组的(17.1±2.6)、(7.9±2.5)min,MA(101.5±6.8)mm、Angle(72.5±9.5)°、CI(4.5±0.2)均大于B组的(69.6±13.6)mm、(27.1±3.8)°、(-15.6±2.6),有统计学差异(P<0.05)。Pearson相关性分析结果显示:产妇出血量与R、K呈显著正相关(r=0.617、0.548,P<0.05),与Angle、CI、MA呈显著负相关(r=-0.568、-0.571、-0.561,P<0.05)。受试者工作特征曲线(ROC曲线)分析结果显示:产妇APTT的曲线下面积(AUC)为0.682(95%CI=0.53,0.834)(P<0.05);PT的AUC为0.748(95%CI=0.61,0.884)(P<0.05)。提示当APTT的AUC为0.682时对产后出血有较低预测价值,PT的AUC为0.748时对产后出血有中等预测价值。结论低Fib值、高APTT和PT值产妇产后有较高出血风险,凝血四项联合血栓弹力图结果能更有效预测产后出血风险。
Objective To explore the clinical value of thromboelastography combined with four coagulation parameters in evaluating the risk of postpartum hemorrhage(PPH)in pregnant women,and to provide evidence-based support for prevention and control of postpartum hemorrhage.Methods A total of 98 postpartum women were collected as the research subjects.They were divided into Group A(bleeding volume<500 ml,n=77)and Group B(bleeding volume≥500 ml,n=21)according to the bleeding volume.The four coagulation parameters were measured in both groups,and thromboelastography analysis was performed.Comparison of four coagulation parameters[activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(Fib),and thrombin time(TT)]between the two groups;analysis of the correlation between PT and the amount of postpartum hemorrhage;comparison of thromboelastogram parameters[reaction time(R),maximum amplitude(MA),kinetics of clot development(K),clot formation rate(Angle),and coagulation index(CI)]between the two groups;analysis of the correlation between amount of postpartum hemorrhage and thromboelastogram parameters;analysis of the predictive efficacy of maternal APTT and PT on postpartum hemorrhage.Results Group A had APTT of(22.8±4.9)s and PT of(10.5±2.1)s,which were significantly shorter than those in Group B[(52.3±9.8)and(21.6±4.3)s];Group A had a significantly higher Fib of(4.1±1.6)g/L than(0.9±0.5)g/L in group B;there were statistical differences(P<0.05).There was no statistically significant difference in TT between the two groups(P>0.05).The results of Pearson correlation analysis showed that PT was positively correlated with the amount of postpartum hemorrhage(r=0.554,P<0.05).Group A had R of(6.8±3.9)min and K of(-2.1±0.3)min,which were shorter than those in Group B[(17.1±2.6)and(7.9±2.5)min];Group A had MA of(101.5±6.8)mm,Angle of(72.5±9.5)°,and CI of(4.5±0.2),which were greater than those of Group B[(69.6±13.6)mm,(27.1±3.8)°,and(-15.6±2.6)];there were statistical differences(P<0.05).The results of Pearson correlation analysis showed that the amount of postpartum hemorrhage was significantly positively correlated with R and K(r=0.617,0.548;P<0.05),and significantly negatively correlated with Angle,CI,and MA(r=-0.568,-0.571,-0.561;P<0.05).The results of the receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)for APTT in postpartum women was 0.682(95%CI=0.53,0.834)(P<0.05);the AUC for PT was 0.748(95%CI=0.61,0.884)(P<0.05).This suggested that when the AUC of APTT was 0.682,it had a low predictive value for postpartum hemorrhage,and when the AUC of PT was 0.748,it had a moderate predictive value for the amount of postpartum hemorrhage.Conclusion Women with low Fib,high APTT and PT values have a higher risk of postpartum hemorrhage.The combination of the coagulation four parameters and thromboelastography can more effectively predict the risk of postpartum hemorrhage.
作者
胡子成
邓辉
HU Zi-cheng;DENG Hui(Blood Transfusion Department,Jiangmen Wuyi Traditional Chinese Medicine Hospital,Jiangmen 529030,China)
出处
《中国实用医药》
2025年第20期19-23,共5页
China Practical Medicine
基金
江门市科技计划项目(项目编号:2022020400970002343)。
关键词
血栓弹力图
凝血四项
产后出血
评估价值
Thromboelastography
Four coagulation parameters
Postpartum hemorrhage
Evaluation value
