中国循证心血管医学杂志
中國循證心血管醫學雜誌
중국순증심혈관의학잡지
CHINESE JOURNAL OF EVIDENCE-BASES CARDIOVASCULAR MEDICINE
2014年
3期
328-330
,共3页
赵树武%王玉平%徐林东%魏刚
趙樹武%王玉平%徐林東%魏剛
조수무%왕옥평%서림동%위강
血栓弹力图%经皮冠状动脉介入术%抗血小板治疗
血栓彈力圖%經皮冠狀動脈介入術%抗血小闆治療
혈전탄력도%경피관상동맥개입술%항혈소판치료
Thromboelastogram%Percutaneous coronary intervention%Antiplatelet therapy
目的:探讨血栓弹力图在冠状动脉介入术患者抗血小板治疗中的应用价值。方法入选90例行冠状动脉介入治疗患者,其中稳定性心绞痛(SAP)、不稳定性心绞痛(UAP)和急性心肌梗死(AMI)患者各30例。所有患者均进行血栓弹力图(TEG)以及凝血功能检测,比较3组患者TEG指标和凝血功能指标及抗血小板治疗反应性差异。结果SAP组、UAP组、AMI组3组患者凝血反应时间(R),血凝块成形时间(K),MA后30min振幅减少百分率(LY30),活化部分凝血活酶时间(APTT),凝血酶时间(TT),国际标准化比较值(INR);水平均值逐渐下降,描记图最大曲线弧度作切线与水平线的夹角(Angle),描记图最大幅度(MA),凝血指数(CI),纤维蛋白原(FIB),D-二聚体(D-D)水平均值逐渐增高,差异有统计学意义(P均<0.01~0.05)。SAP组、UAP组、AMI组三组患者TEG图高凝图形分别为0.0%,33.3%,50.0%,AMI组患者高凝图形发生率明显多于SAP组及UAP组,差异有显著统计学意义(P<0.05)。与抗血小板药物反应正常组(9.2%)比较,抗血小板药物反应低下组(20.0%)患者3个月内缺血心脏事件发生率明显增高,差异有统计学意义(χ2=4.347,P<0.05)。结论血栓弹力图检测有助于指导冠状动脉介入术后患者的抗血小板用药,对降低缺血心脏事件有帮助。
目的:探討血栓彈力圖在冠狀動脈介入術患者抗血小闆治療中的應用價值。方法入選90例行冠狀動脈介入治療患者,其中穩定性心絞痛(SAP)、不穩定性心絞痛(UAP)和急性心肌梗死(AMI)患者各30例。所有患者均進行血栓彈力圖(TEG)以及凝血功能檢測,比較3組患者TEG指標和凝血功能指標及抗血小闆治療反應性差異。結果SAP組、UAP組、AMI組3組患者凝血反應時間(R),血凝塊成形時間(K),MA後30min振幅減少百分率(LY30),活化部分凝血活酶時間(APTT),凝血酶時間(TT),國際標準化比較值(INR);水平均值逐漸下降,描記圖最大麯線弧度作切線與水平線的夾角(Angle),描記圖最大幅度(MA),凝血指數(CI),纖維蛋白原(FIB),D-二聚體(D-D)水平均值逐漸增高,差異有統計學意義(P均<0.01~0.05)。SAP組、UAP組、AMI組三組患者TEG圖高凝圖形分彆為0.0%,33.3%,50.0%,AMI組患者高凝圖形髮生率明顯多于SAP組及UAP組,差異有顯著統計學意義(P<0.05)。與抗血小闆藥物反應正常組(9.2%)比較,抗血小闆藥物反應低下組(20.0%)患者3箇月內缺血心髒事件髮生率明顯增高,差異有統計學意義(χ2=4.347,P<0.05)。結論血栓彈力圖檢測有助于指導冠狀動脈介入術後患者的抗血小闆用藥,對降低缺血心髒事件有幫助。
목적:탐토혈전탄력도재관상동맥개입술환자항혈소판치료중적응용개치。방법입선90례행관상동맥개입치료환자,기중은정성심교통(SAP)、불은정성심교통(UAP)화급성심기경사(AMI)환자각30례。소유환자균진행혈전탄력도(TEG)이급응혈공능검측,비교3조환자TEG지표화응혈공능지표급항혈소판치료반응성차이。결과SAP조、UAP조、AMI조3조환자응혈반응시간(R),혈응괴성형시간(K),MA후30min진폭감소백분솔(LY30),활화부분응혈활매시간(APTT),응혈매시간(TT),국제표준화비교치(INR);수평균치축점하강,묘기도최대곡선호도작절선여수평선적협각(Angle),묘기도최대폭도(MA),응혈지수(CI),섬유단백원(FIB),D-이취체(D-D)수평균치축점증고,차이유통계학의의(P균<0.01~0.05)。SAP조、UAP조、AMI조삼조환자TEG도고응도형분별위0.0%,33.3%,50.0%,AMI조환자고응도형발생솔명현다우SAP조급UAP조,차이유현저통계학의의(P<0.05)。여항혈소판약물반응정상조(9.2%)비교,항혈소판약물반응저하조(20.0%)환자3개월내결혈심장사건발생솔명현증고,차이유통계학의의(χ2=4.347,P<0.05)。결론혈전탄력도검측유조우지도관상동맥개입술후환자적항혈소판용약,대강저결혈심장사건유방조。
Objective To discuss the application value of thromboelastogram (TEG) in antiplatelet treatment in patients with coronary heart disease (CHD) and PCI. Methods The patients (n=90) were chosen and divided into stable angina pectoris group (SAP group), unstable angina pectoris group (UAP group) and acute myocardial infarction group (AMI group, each n=30). All patients were given detections of TEG and coagulation function test, and difference in TEG indexes, coagulation parameters and reactivity to antiplatelet treatment were compared among 3 groups. Results The levels of R, K, LY30, APTT, TT and INR decreased gradually, and levels of Angle, MA, CI, FIB and D-D increased gradually in all groups (all P<0.01-P<0.05). The high coagulation images of TEG were 0.0%, 33.3%and 50.0%respectively in SAP group, UAP group and AMI group. The incidence of high coagulation image was significantly higher in AMI group than that in SAP group and UAP group (P<0.05). The incidence of ischemia cardiac events increased significantly in patients with normal reactivity to antiplatelet treatment (9.2%) than that in those with lower reactivity to antiplatelet treatment (20.0%) within 3 m (χ2=4.347, P<0.05). Conclusion The detection of TEG can guide the administration of antiplatelet drugs and reduce the incidence of ischemia cardiac events.