Department of Anaesthesiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Cardiovascular Surgery and Anaesthesia, Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
Int J Obstet Anesth. 2014 Feb;23(1):10-7. doi: 10.1016/j.ijoa.2013.07.003. Epub 2013 Dec 15.
Haemorrhage is a common cause of morbidity and mortality in the obstetric population. The aim of this study was to compare the use of thromboelastography and laboratory analyses to evaluate haemostasis during major obstetric haemorrhage. A secondary aim was to evaluate correlations between the results of thromboelastography, laboratory analyses and estimated blood loss.
Forty-five women with major obstetric haemorrhage and 49 women with blood loss <600 mL were included. The following thromboelastography analyses were performed: time to start of clotting (TEG-R), time to 20 mm of clot firmness (TEG-K), rate of clot growth (TEG-Angle), maximum amplitude of clot (TEG-MA) and lysis after 30 min (TEG-LY30). In addition, platelet count, activated partial thromboplastin time, prothrombin time, fibrinogen, antithrombin and D-dimer were measured.
Thromboelastography variables reflecting clot stability and fibrinolysis were decreased in women with massive obstetric haemorrhage compared to women with normal bleeding, while clot initiation was accelerated. Laboratory analyses also showed impaired haemostasis with the most pronounced differences in platelet count, fibrinogen concentration and antithrombin activity. The strongest correlations existed between fibrinogen and TEG-MA and between estimated blood loss and TEG-MA, fibrinogen and antithrombin, respectively.
Impaired haemostasis, demonstrated by thromboelastography and laboratory analyses, was found after an estimated blood loss of 2000 mL. Thromboelastography provides faster results than standard laboratory testing which is advantageous in the setting of on-going obstetric haemorrhage. However, laboratory analyses found greater differences in coagulation variables, which correlated better with estimated blood loss.
出血是产科人群发病率和死亡率的常见原因。本研究旨在比较血栓弹力图和实验室分析在评估大出血期间止血的作用。次要目的是评估血栓弹力图、实验室分析和估计出血量之间的结果相关性。
纳入 45 例大出血和 49 例出血量<600mL 的产妇。进行以下血栓弹力图分析：凝血开始时间（TEG-R）、达到 20mm 凝块硬度的时间（TEG-K）、凝块生长速度（TEG-Angle）、最大凝块幅度（TEG-MA）和 30 分钟后溶解（TEG-LY30）。此外，还测量血小板计数、活化部分凝血活酶时间、凝血酶原时间、纤维蛋白原、抗凝血酶和 D-二聚体。
与正常出血产妇相比，大量产科出血产妇的血栓弹力图反映凝块稳定性和纤维蛋白溶解的变量降低，而凝块起始加速。实验室分析也显示出止血功能受损，血小板计数、纤维蛋白原浓度和抗凝血酶活性的差异最明显。纤维蛋白原与 TEG-MA 之间以及估计出血量与 TEG-MA、纤维蛋白原和抗凝血酶之间的相关性最强。
在估计出血量为 2000mL 后，通过血栓弹力图和实验室分析发现止血功能受损。血栓弹力图比标准实验室检测更快地提供结果，这在持续发生产科出血的情况下具有优势。然而，实验室分析发现凝血变量的差异更大，与估计出血量的相关性更好。
