›› 2012, Vol. 32 ›› Issue (11): 1486-.doi: 10.3969/j.issn.1674-8115.2012.11.019

• 论著(临床研究) • 上一篇    下一篇

血栓弹力图与活化凝血时间评价PCI术中普通肝素效果的比较研究

侯旭敏, 戴锦杰, 韩文正, 仇兴标, 方唯一   

  1. 上海交通大学附属胸科医院心内科, 上海 200030
  • 出版日期:2012-11-28 发布日期:2012-11-30
  • 通讯作者: 方唯一, 电子信箱: fwychest@163.com。
  • 作者简介:侯旭敏(1975—), 女, 副主任医师, 博士;电子信箱: xmhou@medmail.com.cn。

Comparison of activated coagulation time and thromboelastography in evaluation of effect of unfractionated heparin during PCI

HOU Xu-min, DAI Jin-jie, HAN Wen-zheng, QIU Xing-biao, FANG Wei-yi   

  1. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2012-11-28 Published:2012-11-30

摘要:

目的 采用血栓弹力图(TEG)和床旁活化凝血时间(ACT)方法,对择期经皮冠状动脉介入治疗(PCI)患者进行术前、术中以及术后凝血功能的测定,评价两种方法的敏感性和相关性。方法 对36例稳定性冠心病拟行择期PCI术的患者,术前予以100 U/kg普通肝素(UFH)静脉注射。分别于PCI术前以及UFH注射后5 min和30 min检测患者外周静脉血ACT和TEG反应时间(TEG-R);并检测PCI术前及术后6、24、72 h的凝血功能指标(PT、APTT)和血常规指标(PLT、RBC、Hb)。结果 UFH注射后5 min,ACT和TEG-R均较基线水平明显延长,差异有统计学意义(P<0.001);UFH注射后30 min,ACT明显缩短(P<0.001),而TEG-R仍保持在较高水平(P>0.05)。PCI术后6 h,PT、APTT、RBC和Hb值均较基线水平有明显变化(P<0.05或P<0.001),但于术后24 h逐渐恢复至术前水平(P>0.05);PLT水平在上述各时间点均无明显变化(P>0.05)。相关性分析显示,TEG-R与ACT呈现高度曲线相关关系(P<0.001)。结论 与ACT比较,TEG-R可以更敏感地检测出残余UFH量;提示TEG检测是评价PCI术中UFH效果敏感且有效的手段。

关键词: 经皮冠状动脉介入治疗, 血栓弹力图, 活化凝血时间, 普通肝素

Abstract:

Objective To determine the coagulation function before, during and after selective percutaneous coronary intervention (PCI) with activated coagulation (ACT) and thromboelastography (TEG), and evaluate the sensitivity and association between these two methods. Methods Thirty-six patients with stable angina undergoing selective PCI were enrolled, and unfractionated heparin (UFH) 100 U/kg was intravenously administered before PCI. ACT and TEG reaction time (TEG-R) were examined before PCI and 5 min and 30 min after UFH administration. The parameters of coagulation function (PT and APTT) and blood routine parameters (PLT, RBC and Hb) were measured before PCI and 6 h, 24 h and 72 h after PCI. Results ACT and TEG-R 5 min after UFH administration were significantly longer than those of baseline (P<0.001), while ACT significantly shortened (P<0.001) and TEG-R still maintained at a higher level (P>0.05) 30 min after UFH administration. There were significant differences between PT, APTT, RBC and Hb 6 h after PCI and those of baseline (P<0.05 or P<0.001), while there was no significant difference between these parameters 24 h after PCI and those of baseline (P>0.05). There was no significant difference in PLT among these time points (P>0.05). Correlation analysis revealed that there was significant curvilinear correlation between ACT and TEG-R (P<0.001). Conclusion TEG-R is more sensitive than TEG-R in detection of residual UFH during PCI, which indicates that TEG may be a useful tool for monitoring of UFH therapy during PCI.

Key words: percutaneous coronary intervention, thrombelastography, activated clotting time, unfractionated heparin