Comparison of Thrombelastography With Common Coagulation Tests in Preeclamptic and Healthy Parturients
Comparison of Thrombelastography With Common Coagulation Tests in Preeclamptic and Healthy Parturients
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DOI：
10.1136/rapm-00115550-199520060-00010
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发表时间：
1995-02
影响因子：
5.1
通讯作者：
C. Wong;Spencer S. Liu;R. Glassenberg
中科院分区：
文献类型：
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作者：
C. Wong;Spencer S. Liu;R. Glassenberg
背景和目标。硬膜外镇痛/麻醉通常有益于先兆子痫的管理和治疗。然而，一些先兆子痫患者有凝血障碍，这是区域麻醉的禁忌症。常规凝血成套检查（RCB）包括凝血酶原时间、部分凝血活酶时间、血小板计数和出血时间，通常用于评估凝血状态。血栓弹力图（TEG）是一种凝血指标，可用于评价总体凝血活性。本研究的目的是检查TEG是否可以预测健康和先兆子痫产妇中RCB诊断的正常和异常凝血。方法. 47名产妇参加了这项前瞻性研究，在第一产程早期进行。20例健康产妇（组I），19例轻度（组II）和8例重度先兆子痫/子痫产妇（组III）进行了RCB和TEG。结果5例患者（1例，I组; 3例，II组; 1例，III组）RCB正常，但TEG轻度异常（K延长，α小）（特异性= 0.88）。27例先兆子痫产妇中有5例（1例，II组; 4例，III组）RCB异常。这5例患者中有3例发生血小板减少症，出血时间和TEG正常。2例患者出现血小板减少、出血时间延长和异常TEG（灵敏度= 0.40）。结论.血栓弹力图不是预测先兆子痫产妇凝血异常的有效方法，如RCB诊断，使用目前定义的正常TEG值为非妊娠患者。然而，异常TEG最大振幅值总是与出血时间延长相关。因此，TEG可用于评估血小板减少症患者的血小板功能。需要进一步研究。
Background and Objectives. Epidural analgesia/anesthesia is often beneficial in the management and treatment of preeclampsia. However, some preeclamptic patients have a coagulopathy that is a contraindication to regional anesthesia. A routine coagulation battery (RCB), consisting of prothrombin time, partial thromboplastin time, platelet count, and bleeding time, is commonly performed to assess coagulation status. Thrombelastography (TEG) is a measure of clotting that allows evaluation of overall coagulation activity. The goal of this study was to examine whether TEG can predict normal and abnormal coagulation as diagnosed by RCB in healthy and preeclamptic parturients. Methods. Forty-seven parturients participated in this prospective study, performed early in the first stage of labor. Twenty healthy parturients (group I), 19 mild (group II), and 8 severe preeclamptic/eclamptic parturients (group III) had RCB and TEG performed. Results. Five patients (1, group I; 3, group II; 1, group III) had a normal RCB, but a mildly abnormal TEG (prolonged K, small α) (specificity = 0.88). Five of 27 preeclamptic parturients (1, group II; 4, group III) had abnormal RCBs. Three of these 5 patients had thrombocytopenia with normal bleeding times and TEGs. Two patients had thrombocytopenia and prolonged bleeding times and abnormal TEGs (sensitivity = 0.40). Conclusions. Thrombelastography is not an effective means of predicting abnormal coagulation, as diagnosed by RCB, in preeclamptic parturients, using currently defined normal TEG values for nonpregnant patients. However, an abnormal TEG maximum amplitude value always correlated with a prolonged bleeding time. Therefore, TEG may be useful in assessing platelet function in the presence of thrombocytopenia. Further studies are warranted.