Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, QLD, Australia; The University of Queensland, Brisbane, QLD, Australia.
Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, QLD, Australia; The University of Queensland, Brisbane, QLD, Australia.
Int J Obstet Anesth. 2019 May;38:10-18. doi: 10.1016/j.ijoa.2019.01.008. Epub 2019 Jan 16.
Formal reference ranges for rotational thromboelastometry (ROTEM®) in pregnancy have not been obtained in the recommended minimum sample size of 120. This prospective observational study aimed to establish baseline parameters in an Australian population of women undergoing elective caesarean delivery. The secondary aim was to compare these reference ranges with those from prior studies and the manufacturer.
Women undergoing elective caesarean delivery at term were included if they were at term, of normal body mass index and had no conditions affecting coagulation. ROTEM® reference ranges were derived by calculating the 2.5 and 97.5 percentiles for INTEM/EXTEM/FIBTEM amplitude at 5 minutes (A5), amplitude at 15 minutes (A15), coagulation time (CT), maximum clot firmness (MCF), and clot formation time (CFT).
Of 202 women screened, 132 met the inclusion criteria, having a mean age of 32.7 ± 5.0 years and median body mass index of 23.8 kg/m (interquartile range 21.5-26.4). The reference ranges for selected ROTEM® parameters were as follows: FIBTEM A5 (13-28 mm), FIBTEM CT (40-74 s), FIBTEM MCF (16-34 mm), EXTEM A5 (39-66 mm), EXTEM CT (43-69 s), INTEM A5 (38-63 mm).
ROTEM® reference ranges for women with uncomplicated term pregnancies were reported as per the International Federation of Clinical Chemistry. The FIBTEM MCF and FIBTEM/EXTEM/INTEM amplitudes were higher in comparison to the manufacturer's reference ranges for the non-obstetric population. The EXTEM CT was shorter than the non-obstetric reference ranges. These ranges show an increase in coagulability during normal pregnancy compared to the non-pregnant reference ranges.
在推荐的最小样本量 120 例中，尚未获得旋转血栓弹性测定法（ROTEM®）在妊娠中的正式参考范围。这项前瞻性观察性研究旨在确定澳大利亚择期剖宫产妇女中的基础参数。次要目标是将这些参考范围与先前的研究和制造商的参考范围进行比较。
如果患者足月、体重指数正常且无影响凝血的疾病，则纳入接受择期剖宫产的女性。通过计算 INTEM/EXTEM/FIBTEM 振幅在 5 分钟时（A5）、15 分钟时（A15）、凝血时间（CT）、最大血凝块硬度（MCF）和血凝块形成时间（CFT）的第 2.5 和 97.5 百分位数，得出 ROTEM®参考范围。
在筛查的 202 名女性中，有 132 名符合纳入标准，平均年龄为 32.7±5.0 岁，中位数体重指数为 23.8kg/m（四分位距 21.5-26.4）。选定 ROTEM®参数的参考范围如下：FIBTEM A5（13-28mm）、FIBTEM CT（40-74s）、FIBTEM MCF（16-34mm）、EXTEM A5（39-66mm）、EXTEM CT（43-69s）、INTEM A5（38-63mm）。
按照国际临床化学联合会的要求，报告了无并发症足月妊娠女性的 ROTEM®参考范围。与非产科人群的制造商参考范围相比，FIBTEM MCF 和 FIBTEM/EXTEM/INTEM 振幅更高。EXTEM CT 比非产科参考范围更短。与非妊娠参考范围相比，这些范围显示正常妊娠期间凝血能力增加。
