Value of maximal amplitude in thrombelastography for pregnant women with thrombocytopenia
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摘要: 目的:本研究旨在探讨血栓弹力图(TEG)最大血块强度(MA)值在血小板减少孕妇中的作用。方法:选取2015-08-2017-12入住本院产科的血小板减少孕妇111例,血小板计数正常的孕妇24例。比较血小板计数与TEG参数之间的相关性;比较不同血小板计数孕妇在分娩方式、血小板输注例数和输注量上的差异;孕妇分娩前和(或)分娩时是否输注血小板的多因素分析;比较血小板计数和TEG参数MA值与产时、产后24 h出血量的相关性;分别比较TEG参数MA<50组与MA ≥ 50组以及血小板减少组与血小板正常组孕妇在产时、产后24 h出血量、血小板及红细胞输注量的差异;比较剖宫产与阴道分娩孕妇在血小板计数和MA值上的差异。结果:血小板计数与TEG参数有相关性(P<0.05);血小板计数<50×109/L的孕妇,均采取剖宫产分娩且均输注血小板。血小板计数正常的孕妇均未输注血小板。MA值、血小板计数和分娩方式对孕妇是否输注血小板具有预测价值(P<0.05)。血小板计数与产时、产后24 h出血量之间无相关性(P>0.05),而TEG参数MA与其有相关性(P<0.05)。血小板减少组与血小板正常组孕妇在产时、产后24 h出血量及红细胞输注量上均差异无统计学意义(P>0.05)。而MA<50的孕妇均高于MA ≥ 50的孕妇,差异有统计学意义(P<0.05)。剖宫产和阴道分娩在MA值上差异有统计学意义(P<0.05),但在血小板计数上差异无统计学意义(P>0.05)。结论:TEG参数MA值能预测血小板减少孕妇分娩前和(或)分娩时的血小板输注,能较好评估产时、产后24 h出血量及红细胞输注量,可用于血小板减少孕妇临床出血倾向评估及指导分娩方式选择。Abstract: Objective:To explore the value of maximal amplitude(MA)in thrombelastography(TEG)for pregnant women with thrombocytopenia.Method:111 cases pregnant women with thrombocytopenia and 24 cases pregnant women with normal platelet count from August 2015 to December 2017 in our hospital were selected.The correlation between platelet count and TEG parameters was compared.The difference between groupⅠ,Ⅱ and Ⅲ on delivery mode,platelet infusion cases and infusion quantity was compared.Multi-factor analysis of platelet transfusion in pregnant women with thrombocytopenia was done.The correlation between platelet count,MA and postpartum haemorrhage was compared.The differences between MA<50 and MA ≥ 50 group or PLT<50×109/L and PLT ≥ 50×109/L group were compared on intrapartum,24 hour postpartum haemorrhage,platelet and blood infusion quantity,respectively.The difference between cesarean section and vaginal delivery women on platelet count and MA value was compared.Result:There was correlation between platelet count and TEG parameter(P<0.05).All PLT<50×109/L(groupⅠ)taken cesarean delivery and platelet transfusion.None normal platelet count pregnant women(group Ⅲ)taken platelet transfusion.MA,platelet count and delivery mode had predictive value for platelet transfusion of pregnant women with thrombocytopenia.There was no correlation between platelet count and intrapartum,24 hour postpartum haemorrhage(P>0.05).There was no difference between PLT<50×109/L and PLT ≥ 50×109/L group on intrapartum,24 hour postpartum haemorrhage,platelet and blood infusion quantity(P>0.05).But the difference between MA<50 and MA ≥ 50 group was statistically significant(P<0.05).The difference between cesarean section and vaginal delivery on the MA value was statistically significant(P<0.05),but there was no statistically significant difference on platelet count(P>0.05).Conclusion:MA can predict platelet transfusion for pregnant women with thrombocytopenia.It is helpful in evaluating the amount of intrapartum,24 hour postpartum haemorrhage and blood transfusion.It can be used for clinical bleeding tendency assessment and delivery mode choice of pregnant women with thrombocytopenia.
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Key words:
- thrombocytopenia /
- thrombelastography /
- postpartum haemorrhage
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