首页|超声检测联合血栓弹力图预测早期流产并指导抗凝治疗的临床价值

超声检测联合血栓弹力图预测早期流产并指导抗凝治疗的临床价值

Clinical value of ultrasonic testing combined with thromboelastography to predict early abortion and guide the anticoagulant therapy

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目的 分析超声检测孕妇卵黄囊状态与基线血栓弹力图指标在评估不同妊娠结局与抗凝结局中的临床价值.方法 收集 215 例孕妇,其中早期妊娠正常孕妇 87 例,作为A组;出现阴道流血、下腹部疼痛等早期流产症状的孕妇 128 例,根据妊娠结局不同分为B组(先兆流产妊娠结局良好,70 例)和C组(先兆流产妊娠结局不良,58 例).经阴道超声对孕妇进行检查,记录卵黄囊直径、妊娠囊大小、胎芽长度及有无原始心管搏动等数据.对孕妇进行血栓弹力图凝血分析,记录反应时间(R)值、凝血时间(K)值、Angel角、最大振幅(MA)值、凝血综合系数(CI)值.比较三组超声检测卵黄囊情况(卵黄囊显示率、卵黄囊直径)、血栓弹力图基线资料,C组孕 8~12、12~16 周出现高凝状态孕妇治疗前后血栓弹力图指标变化情况.结果 A组卵黄囊显示率为 89.66%、B组为 87.14%,均高于C组的 55.17%,差异具有统计学意义(P<0.05);三组卵黄囊显示率比较差异有统计学意义(P<0.05).A组、C组孕 7~8、8~9、9~10、10~11、11~12 周卵黄囊直径均大于B组,且A组小于C组,差异具有统计学意义(P<0.05);三组孕 7~8、8~9、9~10、10~11、11~12 周卵黄囊直径比较差异有统计学意义(P<0.05).三组R值、K值、Angel角、MA值、CI值比较,差异有统计学意义(P<0.05).C组R值、K值均低于A组、B组,Angel角、MA值、CI值均高于A组、B组,差异有统计学意义(P<0.05).C组于孕 8~12 周出现高凝状态的孕妇 25 例,于孕 12~16 周出现高凝状态的孕妇 28 例.C组孕 8~12 周出现高凝状态孕妇治疗后R值、K值、Angel角、MA值、CI值分别为(7.31±0.45)min、(1.96±0.31)min、(75.78±7.21)°、(62.21±7.11)mm、(2.78±0.51),均优于治疗前的(5.79±0.51)min、(0.99±0.33)min、(86.29±6.21)°、(71.78±7.29)mm、(5.51±1.21),差异有统计学意义(P<0.05).C组孕 12~16 周出现高凝状态孕妇治疗后R值、K值、Angel角、MA值、CI值分别为(7.01±0.44)min、(1.92±0.34)min、(75.12±7.11)°、(61.21±7.49)mm、(2.32±0.31),均优于治疗前的(5.51±0.41)min、(0.91±0.31)min、(88.29±6.48)°、(73.78±7.21)mm、(5.62±1.01),差异有统计学意义(P<0.05).结论 超声检测的卵黄囊直径大小与妊娠结局有关,偏大或偏小均会导致流产.基线血栓弹力图指标可以有效反映孕妇流产的发生几率,高凝患者经抗凝治疗后指标好转,因此可以用基线血栓弹力图指标评估抗凝治疗的有效性,指导临床抗凝治疗.
Objective To analyze the clinical value of ultrasonic detection of yolk sac status and baseline thromboelastography in evaluating different pregnancy outcomes and anticoagulation outcomes.Methods A total of 215 pregnant women were collected,of which 87 normal pregnant women with early pregnancy were selected as group A,128 pregnant women with early symptoms of abortion such as vaginal bleeding and lower abdominal pain were divided into group B(threatened abortion with good pregnancy outcome,70 cases)and group C(threatened abortion with poor pregnancy outcome,58 cases)according to the different pregnancy outcomes.The patients were examined by transvaginal ultrasound,and data such as the diameter of the yolk sac,the size of the gestational sac,the length of the fetal bud,and the presence or absence of primitive heart tube pulses were recorded.Thromboelastographic coagulation analysis was performed on pregnant women,and the reaction time(R)value,clotting time(K)value,Angel angle,maximum amplitude value,and clot index(CI)value were recorded.Comparison of ultrasound testing of yolk sacs(display rate of yolk sac,diameter of yolk sac),baseline data of thromboelastography among the three groups,and changes in thromboelastography indicators before and after the treatment of pregnant women with hypercoagulation at 8-12 and 12-16 weeks'gestation in group C.Results The display rate of yolk sac was 89.66%in group A,87.14%in group B,which was higher than 55.17%in group C,and the difference was statistically significant(P<0.05).There was significant difference in the display rate of yolk sac among the three groups(P<0.05).The yolk sac diameter of group A and group C was higher than that of group B at 7-8,8-9,9-10,10-11 and 11-12 weeks'gestation,and group A was smaller than group C.The difference was statistically significant(P<0.05).There were significant differences in yolk sac diameter among the three groups at 7-8,8-9,9-10,10-11 and 11-12 weeks'gestation(P<0.05).The R value,K value,Angel Angle,MA value and CI value of the three groups were compared,and the difference was statistically significant(P<0.05).The R and K values of pregnant women in group C were lower than those in group A and group B,while the Angel angle,MA and CI values of pregnant women in group C were higher than those in group A and group B.The difference was statistically significant(P<0.05).There were 25 pregnant women in group C who developed hypercoagulation at 8-12 weeks'gestation,and 28 pregnant women who developed hypercoagulation at 12-16 weeks'gestation.The R value,K value,Angel angle,MA value,and CI value of pregnant women with hypercoagulation at 8-12 weeks'gestation in group C were(7.31±0.45)min,(1.96±0.31)min,(75.78±7.21)°,(62.21±7.11)mm,and(2.78±0.51)after treatment,which were superior to(5.79±0.51)min,(0.99±0.33)min,(86.29±6.21)°,(71.78±7.29)mm,and(5.51±1.21)before treatment,and the difference was statistically significant(P<0.05).The R value,K value,Angel angle,MA value,and CI value of pregnant women with hypercoagulation at 12-16 weeks'gestation in group C were(7.01±0.44)min,(1.92±0.34)min,(75.12±7.11)°,(61.21±7.49)mm,(2.32±0.31)after treatment,which were better than(5.51±0.41)min,(0.91±0.31)min,(88.29±6.48)°,(73.78±7.21)mm,and(5.62±1.01)before treatment,and the difference was statistically significant(P<0.05).Conclusion The diameter of the yolk sac detected by ultrasound is related to the pregnancy outcome.If it is too large or too small,it will lead to miscarriage.Baseline thromboelastography indicators can effectively reflect the probability of miscarriage.Patients with hypercoagulation have improved indicators after anticoagulation treatment.Therefore,baseline thromboelastography indicators can be used to evaluate the effectiveness of anticoagulation therapy and guide clinical anticoagulation treatment.

Ultrasonic testingThromboelastographyEarly abortionYolk sacAnticoagulant therapy

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518106 深圳市光明区人民医院

超声检测 血栓弹力图 早期流产 卵黄囊 抗凝治疗

2022年度光明区卫生系统科研项目

gmws2022064

2024

中国实用医药
中国康复医学会

中国实用医药

影响因子:0.797
ISSN:1673-7555
年,卷(期):2024.19(18)