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TEG血栓弹力图在妇产科的临床应用【PPT】

  • 2026-06-24 04:47:21
TEG血栓弹力图在妇产科的临床应用【PPT】
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读完这份TEG血栓弹力图的PPT，把核心内容梳理了一下。
TEG和常规凝血检测的区别在于，常规检测只能看凝血过程的某一个环节，比如PT、APTT、血小板计数这些，没法反映整个凝血过程的动态变化。TEG则是从凝血启动到血凝块形成再到纤溶溶解，全程监测，相当于把整个凝血过程画成了一条曲线。
TEG的原理是，杯体带着血样持续旋转振荡，随着血凝块形成，杯盖的运动会受到牵制，系统把这个牵制力记录下来画成图形。血栓弹力图仪就是这么个工作方式。
核心参数有五个。
R值是凝血时间，从检测开始到纤维蛋白形成，反映凝血因子的活性，正常5到10分钟。R值延长说明凝血因子缺乏，缩短说明处于高凝状态。
K值和a角反映血块形成的速度，跟纤维蛋白原水平和血小板聚集功能有关。K值正常1到3分钟，a角正常53到72度。K值延长或a角减小说明低凝，缩短或增大说明高凝。
MA值是最大血块强度，正常50到70毫米。血小板贡献了大约八成，纤维蛋白原贡献大约两成。MA值降低说明血小板功能不良或纤维蛋白原不足，升高说明功能亢进或高纤维蛋白原血症。
LY30和EPL反映纤溶功能，LY30是30分钟内血块溶解的百分比，正常0到8%，EPL是预测纤溶百分比，正常0到15%。超过正常值说明纤溶亢进。
图形识别方面，正常凝血曲线形态适中。低凝状态R值和K值都延长，MA值降低，曲线右移振幅减小。高凝状态相反，R值和K值缩短，MA值升高，曲线左移振幅增大。纤溶亢进要看LY30和EPL明显升高。
PPT里放了六个案例。
第一个是凝血因子缺乏，R值延长到15.4分钟，其他参数基本正常，处理建议是排除肝素影响后输新鲜冰冻血浆。
第二个显示K值延长、a角明显减小，提示低纤维蛋白原水平，建议输冷沉淀或新鲜冰冻血浆。
第三个MA值低于正常下限，48.1毫米，提示血小板功能不良，建议输注血小板制剂。
第四个MA值升高到78.8毫米，提示高血小板功能，处于高凝状态，建议抗血小板治疗。
第五个案例R值2.2分钟、K值1.0分钟、MA值73.8毫米，R值和K值都缩短，MA值升高，a角也增大，提示高凝血因子活性和高血小板功能并存，血栓风险显著增加，建议抗血小板加抗凝双重预防。
第六个纤溶亢进，原发性的凝血正常但纤溶异常，治疗以抗纤溶为主；继发性的凝血异常在先、纤溶在后，治疗以抗凝为主。
临床应用方面，PPT引用了产后出血管理共识，建议早期用TEG评估凝血状态，TEG能提供快速结果和全面信息指导止血治疗。也有研究显示TEG可以帮助区分恶性肿瘤女性患者的高凝状态，用于血栓风险分层。
PPT还给出了输血指导的具体触发值，产后出血时R值超过8.3分钟考虑输新鲜冰冻血浆，K值超过2.0分钟输冷沉淀，MA值低于69.4毫米或者a角低于65.7度输血小板，LY30超过7.5%提示纤溶亢进要抗纤溶处理。
检测时间点建议入院时做一次建立基线，住院期间根据临床需要选择不同检测项目，出院后随访根据情况复查。
TEG在妇产科的价值在于，术前可以评估出血风险，术中术后可以指导产后出血管理和输血决策，还能早期识别DIC和高凝状态、对血栓风险做分层。凝血管理从诊断到治疗都能覆盖，信息量比常规检测大得多。
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  1. CONNECT:[ UseTime:0.000435s ] mysql:host=127.0.0.1;port=3306;dbname=h_sjds;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.000610s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.000311s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.000289s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.000509s ]
  6. SELECT * FROM `set` [ RunTime:0.000206s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.000604s ]
  8. SELECT * FROM `article` WHERE `id` = 534090 LIMIT 1 [ RunTime:0.005640s ]
  9. UPDATE `article` SET `lasttime` = 1782408481 WHERE `id` = 534090 [ RunTime:0.015693s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 64 LIMIT 1 [ RunTime:0.001459s ]
  11. SELECT * FROM `article` WHERE `id` < 534090 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.001083s ]
  12. SELECT * FROM `article` WHERE `id` > 534090 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.001282s ]
  13. SELECT * FROM `article` WHERE `id` < 534090 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.015444s ]
  14. SELECT * FROM `article` WHERE `id` < 534090 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.002467s ]
  15. SELECT * FROM `article` WHERE `id` < 534090 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.011889s ]
0.144075s