·97·
安徽卫生职业技术学院学报 2020年19卷第6期
凝血七项对羊水栓塞及DIC的诊断及预后
范存琳 唐金凤 周林玉
【中图分类号】 R473.71 【文献标识码】 A 【文章编号】 1671-8054(2020)06-0097-02【摘 要】 目的:探讨正常孕产妇各期的凝血四项及纤溶功能的变化。方法:选择148例早期和晚期孕妇及DIC患者,分为早
孕组(B组)、晚孕组(C组)及DIC组(D组)。分别检测PT、FIB、APTT、TT、D-二聚体水平及FDP,对照组(A组)为体检中心非孕妇健康者。结果:各孕期组与健康对照组比较,FIB、D-二聚体明显升高,PT、APTT、TT明显减低,差异有统计学意义(P <0.05),FDP差异无统计学意义。D组PT、FIB、APTT、TT、D-二聚体及FDP与各孕期健康对照组差异具有统计学意义(P <0.05),D组D-二聚体、FDP显著高于A组,PT和INR、APTT、TT明显高于A组,FIB明显低于A组。结论:孕妇各期PT、FIB、APTT、TT、D-二聚体及FDP变化不同,有利于临床医生正确反映孕产妇体内凝血及纤溶的状态,对及预防孕产妇产中及产后DIC有着极其重要的意义。
【关键词】 孕产妇 凝血四项 FDP D-二聚体
吴辉孕产妇在正常分娩前后,凝血功能和纤溶状态随着孕期及产程发展过程中女性激素水平逐渐升高,在晚期可达到高峰,这将影响肝脏的合成、代谢及分泌,正常孕产妇分娩前血液一般处于高凝的状态,分娩后72 h基本恢复。产妇弥散性血管内凝血DIC可引起严重的并发症,导致各器官功能障碍和休克,血循环障碍,甚至危及生命[1]。因此,孕产妇孕期及分娩后联合检测血凝四项、FDP、D-二聚体、可全面反映孕产妇凝血及纤溶状态的平衡,对及预防孕产妇因DIC等出血性疾病带来的危险因素及评价预后有着极其重要的临床意义。通过检测孕妇凝血四项(PT、APTT、TT、FIB)及血浆FDP、D-二聚体、组织抗凝因子等检测指标,能正确分析研究孕妇正常分娩前后的凝血与纤溶功能状态[2],为临床选择适宜的生产方式提供参考,避免不必要的风险,对预防和产后大出血及产科DIC的危险以及评估预后有着重要临床实用价值[3]
。现将研究报告如下:1 资料与方法1.1 一般资料 选择四类孕产妇为实验研究对象。选择本医院2018年1月-2018年12月门诊及住院孕产妇,年龄23~34岁,平均年龄(28.89± 5.98)岁,无异常病史,无近期服药史,各项实验室检查在正常评估范围内以及心电图无异常的孕产妇。依照妇产科学各孕期分类标准[4]以及全国血栓及止血学术会议制定的标准[5]将其分成四组,分别是A组(健康对照组)37例,B(组早孕组)37例,C组(晚孕组)37例,D组(DIC组)37例。1.2 仪器 采用全自动血凝分析仪日本希森美康Cs-5100。及由德国的西门子公司提供的试剂和定标血浆,全部为日本希森
美康Cs-5100全自动血凝分析仪的配套试剂。1.3 检测方法 研究对象均为清晨空腹静脉血2.70 mL,和枸橼酸钠(109 mmol/L)真空抗凝管充分混合颠倒摇匀6~8次,采用免疫投射比浊法在一定时间内分别检测PT、FIB、APTT、TT、D-二聚体水平及FDP。整个实验过程严格按照说明书操作,血浆质控品将随着样本同时进行。1.4 统计学方法 此研究数据均采用SAS8.1软件进行统计,计量数据采用t 检验,P <0.05表示差异具有统计学意义。2 结 果
各孕期组与健康对照组比较,FIB、D-二聚体明显升高,PT、APTT、TT明显减低,差异有统计学意义(P <0.05),FDP差异无统计学意义。D组PT、FIB、APTT、TT、D-二聚体及FDP与各孕期健康对照组比较,差异均有统计学意义(P <0.05);D组患者的D-二聚体、FDP显著高于A组,PT和INR、APTT、TT明显高于A组,FIB明显低于A组,差异具有统计学意义(P <0.05)。见表1。
表1 四组研究对象PT、FIB、TT、APTT、D-Dimer和FDP的比较(x ±s )
组别
n PT FIB TT APTT D-Dimer FDP 对照组(A 组)3710.1±0.2 3.1±0.118.6±0.323.9±0.40.4±0.04 3.9±0.3早孕组(B 组)3710.5±0.2 4.0±0.116.0±0.223.3±1.5 1.5±0.3 2.2±0.1晚孕组(C 组)3710.5±0.1 4.6±0.117.3±0.228.1±0.4 1.2±0.1 3.0±0.2DIC 组(D 组)
37
21.8±0.40.7±0.0237.7±0.772.5±1.836.3±1.748.4±2.2F 494.64271.96617.16625.33406.95411.70P
0.00
0.00
0.00
0.00
0.00
0.00
3 讨 论
产科羊水栓塞一般发生在产时或者破膜时,也可发生于产后,一般见于足月产,有时也见于
作者单位:赣州市人民医院检验科 江西赣州 341000 2020-08-10收稿,2020-09-10修回
医学基础与药学研究·98·
中期引产或者钳刮术中,大多数发病突然。羊水栓塞发病凶险,大多来不及做相关检查时患者就已经死亡,部分羊水栓塞患者经抢救渡过了阶段,继而出现DIC,临床表现为以阴道大量出血为主的全身出血倾向。因此,早期诊断极其重要。本项目拟通过检测孕妇凝血四项(PT、APTT、TT、FIB)及血浆FDP、D-二聚体、组织抗凝因子等检测指标,到能较全面反映孕产妇凝血功能和纤溶之间的平衡状态点,对和预防孕产妇因血栓性疾病、出血而带来的危险以及评估预后有着重要临床实用价值[6]。
通过对本医院就诊的资料完整的早晚期孕妇及羊水栓塞,DIC的妇女分别进行凝血四项、FDP及D-二聚体及组织抗凝因子等检测,检测结果可以为临床医师提供更好的诊疗依据,判断患者是否处于血栓前状态或高凝状态,以便更好地对各期孕产妇进行早期监测、早期预防,防止血栓形成[7]。四组结果显示,D组患者的PT、APTT、TT、D-Dimer和FDP明显高于其他三组,D组FBG则明显低于其他三组。所以说D-Dimer和FDP联合检测对诊断对预防和产后大出血及产科DIC的危险,监测疾病发展以及评估预后有着重要临床实用价值。
参考文献
[1] 许秀华.产妇DIC中凝血与纤溶水平临床分析[J].中国临床实用医学,2010,4(4):14.
[2] 刘祥平.血浆D二聚体和FDP联合检测在DIC中的应用[J].吉林医药,2014,5(11):915.
[3] 胡可,王珂.血浆D二聚体及FDP检测在DIC诊断中的意义[J].重庆医学,2004,33(11):1666-1668. [4] 丰有吉,主编.妇产科学[M].第6版,北京:人民卫生出版社,2002:30-31.
[5] 第七届全国血栓与止血学术会议组.第七届全国血栓与止血学术会议组制定的几项诊断参考标准[J].中华血液学杂志,2000,21(3):165-168.
[6] 崔秀凤,郭兰,赵俊暕,等.FIB,D-D对孕妇DIC前期的早期诊断意义[J].中国妇幼保健,2009,24(23):3222.
[7] 裴斌,刘利,吴辉.凝血与纤溶指标在产科弥漫性血管内凝血诊断中的意义[J].检验医学与临床,2009, 6(2):100.
Diagnosis and prognosis of amniotic fluid embolism and DIC by coagulation tetraethylene, D-dimer, tissue anticoagulant factor and FDP
Ganzhou People's Hospital,Ganzhou 341000,Jiangxi
FAN Cun-lin,TANG Jin-feng, ZHOU Lin-yu
Abstract:Objective:To study the changes of coagulation and fibrinolytic function in no
rmal maternal period. Methods: 148 early and late pregnant women and DIC patients were selected. The early pregnancy group was group B, late pregnancy group was group C and DIC group D. PT, FIB, APTT, TT, D-dimer levels and FDP were detected respectively. Group A of the control group was a non-pregnant woman in the physical examination center. Results: Compared with the health control group in pregnancy group, FIB and D-dimer increased significantly, PT, APTT, TT, decreased significantly, the difference was statistically significant (P<0.05), and FDP had no statistical significance. D group PT, FIB, APTT, TT, D-dimer, and FDP were all significantly different from the control group of pregnancy health (P<0.05), D group D-dimer, FDP were significantly higher than Group A, PT and INR, APTT, TT were significantly higher than Group A, FIB was significantly lower than Group A. Conclusion: Different changes of PT, FIB, APTT, TT, D-dimer and FDP in pregnant women are helpful for clinicians to correctly reflect the state of coagulation and fibrinolysis in pregnant women, and to treat and prevent DIC during and after pregnancy.
Key Words:maternity; blood clotting; FDP; d-dimer
Application effect of evaluation intervention based on MMSE scale in elderly
patients with alzheimer's disease
Anhui Medical University Affiliated Psychological Hospital, Hefei 230022, Anhui
GE Xiu-juan, HONG Qing, ZHAI Wen-juan, et al
Abstract:Objective:To explore the effect of evaluation intervention based on MMSE scale in elderly patients with Alzheimer's disease. Methods:A total of 130 elderly patients who underwent Alzheimer's disease in hospital were randomly divided into the conventional group and the study group. Each group of patients had 65 patients. According to the nursing intervention, the patients in the study group were evaluated based on the MMSE scale on the basis of traditional nursing intervention. The cognitive function, daily living ability and quality of life of the two groups were compared before and after intervention. Results:At 6 months after intervention, the MMSE score and ADAS-cog score of the study group. the scores, the ADCS-ADL score, and the ADCS-ADL score, which was significantly better than the conventional group (P<0.05). Conclusion:The evaluation
of MMSE scale in elderly patients with Alzheimer's disease can effectively improve the cognitive function of patients, and it is also important to improve patients' daily living ability and quality of life.
Key Words:elderly patients; alzheimer's disease; cognitive function; daily living ability
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