CN107300622A - A kind of Forecasting Methodology of amniotic fluid embolism coagulation disorders - Google Patents
A kind of Forecasting Methodology of amniotic fluid embolism coagulation disorders Download PDFInfo
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- CN107300622A CN107300622A CN201710722870.3A CN201710722870A CN107300622A CN 107300622 A CN107300622 A CN 107300622A CN 201710722870 A CN201710722870 A CN 201710722870A CN 107300622 A CN107300622 A CN 107300622A
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Abstract
The present invention relates to a kind of Forecasting Methodology of amniotic fluid embolism coagulation disorders, by using the thrombelastogram of coagulation process and fibrinolytic overall picture can be reflected, pregnant woman's whole blood is carried out using the amniotic fluid and urokinase of suitable concentration external evoked, blood is excited high solidifying and fibrinolytic process occur, sensitiveness and tolerance of the pregnant woman to amniotic fluid and urokinase are evaluated by the change of thrombelastogram index, prediction amniotic fluid causes the possibility that blood coagulation disorders occurs；As LY30 Zhi≤7.5, the incidence of the amniotic fluid of pregnant woman embolism coagulation disorders is higher, should do sth. in advance examination and take measures to prevent the generation of amniotic fluid embolism.
Description
Technical field
The invention belongs to the technical field of Hemostasis examination, and in particular to a kind of prediction side of amniotic fluid embolism coagulation disorders
Method.
Background technology
Amniotic fluid embolism is a kind of pregnant allergic reaction syndrome, and patient is usually expressed as anaphylactic shock and acute pulmonary embolism
Performance.Also researcher thinks that amniotic fluid embolism is a kind of consumption coagulopathy, patient shows a large amount of blood coagulation substance consumption and fibrinolytic
Hyperfunction, puerpera's systemic bleeding causes puerpera's massive haemorrhage and dead.There is presently no the experimental method of prevention detection, if can be in production
Preceding prediction and examination amniotic fluid embolism coagulation disorders people at highest risk, set up sensitive reliably test method significant.
Miriam J.P.Harnett use influence of the thrombelastogram observation in vitro amniotic fluid to pregnant woman's coagulation function, and amniotic fluid is thought in research
Gao Ning generation is further excited, but experiment is not carried out the change of fibrinolysis index.
Thrombelastogram (thrombelastography, TEG) is main to be examined in the coagulation function for being clinically used for whole blood sample
Survey.Thrombelastogram sample is the whole blood sample of patient, and the whole blood sample of patient is placed in specimen cup during detection, and connection is moved
Sensing and conducting system detection bar insertion sample cup, make sample under 37 DEG C of constant temperature by kaolin solution activate after examined
Survey.Specimen cup is with 4 degree 45 points of angular speed uniform rotation, and detection bar, which then senses the resistance of sample motion and carries out record generation, retouches
Note figure and parameter.Graphy figure is roughly divided into two parts, blood coagulation stage and fibrinolytic stage.In the blood coagulation stage, the R times are detection
The time required to starting to curve amplitude rises to 2mm, a variety of clotting factor of correspondence, which are progressively activated, causes fibrin to initially form
Process.The K times are the time required to curve amplitude rises to 20mm by 2mm, the crosslinking of correspondence fibrin and its with it is hematoblastic
Interaction.A angles are the tangent line and horizontal angle of graphy figure maximum curve radian, reflect fibrin jointly with the K times
With hematoblastic interaction, as important Substitute Indexes when the serious low solidifying K values of patient can not be measured.Peak swing
(maximum amplitude, MA) is graphy figure crest amplitude, correspondence clot maximum intensity, with platelet concentration, blood platelet work(
Energy and platelet-fibrin interaction are relevant.Clot, which reaches, just enters the fibrinolytic stage after maximum intensity, wherein more common
Index be Ly30 and Ly60, the percentage of thrombus fibrinolytic when graphy figure reaches 30 minutes and 60 minutes after MA is represented respectively, by
The TG-AUC of reduction is calculated, and reacts the degree of fibrinolysin thrombus.
The content of the invention
In order to solve the above mentioned problem of prior art presence, the invention provides a kind of amniotic fluid embolism coagulation disorders
Forecasting Methodology.The inventive method is based on thrombelastogram, and use can reflect the thrombelastogram of coagulation process and fibrinolytic overall picture, right
Pregnant woman's whole blood carries out amniotic fluid and urokinase is external evoked, excites blood Gao Ning (consumption of coagulation factors) and fibrinolytic process (urine occur
Kinases is induced), sensitiveness and tolerance of the pregnant woman to amniotic fluid and urokinase are evaluated by the change of thrombelastogram index, in advance
Survey the possibility that amniotic fluid causes blood coagulation disorders to occur, ahead of time examination and the generation of prevention amniotic fluid embolism.
The technical solution adopted in the present invention is：
Application of the thrombelastogram in prediction amniotic fluid embolism coagulation disorders.
A kind of method that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, is comprised the following steps：
(1) blood sample is fully activated first with kaolin solution, blood sample after being activated；
(2) blood sample after the activation is added in the specimen cup for filling calcium chloride solution, then delayed into the specimen cup
It is slow to add amniotic fluid and urokinase, obtain blood sample to be measured；The calcium chloride solution, amniotic fluid, urokinase and blood sample after the activation
The ratio between volume is 15-25:5-30:5-30:300-400；
(3) blood sample to be measured is placed in thrombelastogram instrument and tested, obtain Indicators of Fibrinolysis LY30 values.
The activity of the urokinase is 20-200U/ml.
In step (1), kaolin solution and blood sample are sufficiently mixed to activate blood sample, and the time of the progress activation is
3-6min。
In step (1), the concentration of the kaolin solution is 0.2-0.5mg/ml.
The ratio between volume of the kaolin solution and the blood sample is 5:400-15:300.
In step (2), in the specimen cup, the addition of the amniotic fluid is 5-30 μ l.
In step (2), in the specimen cup, the addition of the urokinase is 5-30 μ l.
In step (2), in the specimen cup, the concentration of the calcium chloride solution is 0.1-0.5mol/L.
During LY30 Zhi≤7.5, the incidence of amniotic fluid embolism coagulation disorders is high.
Beneficial effects of the present invention are：
The Forecasting Methodology of amniotic fluid embolism coagulation disorders of the present invention, by using coagulation process and fibre can be reflected
The thrombelastogram of molten overall picture, it is external evoked using amniotic fluid and the urokinase progress of suitable concentration to pregnant woman's whole blood, excite blood
There is Gao Ning (consumption of coagulation factors) and fibrinolytic process (urokinase induction), evaluated by the change of thrombelastogram index pregnant
Woman predicts the possibility that amniotic fluid causes blood coagulation disorders to occur to the sensitiveness and tolerance of amniotic fluid and urokinase；When LY30 Zhi≤
When 7.5, the incidence of the amniotic fluid of pregnant woman embolism coagulation disorders is higher, should do sth. in advance examination and take measures to prevent amniotic fluid bolt
The generation of plug.
Embodiment
To make the object, technical solutions and advantages of the present invention clearer, technical scheme will be carried out below
Detailed description.Obviously, described embodiment is only a part of embodiment of the invention, rather than whole embodiments.Base
Embodiment in the present invention, those of ordinary skill in the art are resulting on the premise of creative work is not made to be owned
Other embodiment, belongs to the scope that the present invention is protected.
Embodiment 1
The present embodiment provides a kind of method that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, including as follows
Step：
(1) it is sufficiently mixed first with 5 μ l concentration for 0.5mg/ml kaolin solution and 300 μ l blood samples to activate blood
Sample, the time for carrying out the activation is 3min, blood sample after being activated；
(2) blood sample after the activation is added to and filled in the specimen cup that 15 μ l concentration are 0.5mol/L calcium chloride solutions,
5 μ l amniotic fluid and 5 μ l urokinases (enzymatic activity of urokinase is 20U/ml) are slowly added into the specimen cup again, blood to be measured is obtained
Sample；
(3) blood sample to be measured is placed in thrombelastogram instrument and tested, obtained Indicators of Fibrinolysis LY30 values, work as LY30
During Zhi≤7.5, the incidence of the amniotic fluid of pregnant woman embolism coagulation disorders is higher, and intervening measure should be taken in advance.
Embodiment 2
The present embodiment provides a kind of method that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, including as follows
Step：
(1) it is sufficiently mixed to activate for 0.2mg/ml kaolin solution and 400 μ l blood samples first with 15 μ l concentration
Blood sample, the time for carrying out the activation is 6min, blood sample after being activated；
(2) blood sample after the activation is added to and filled in the specimen cup that 25 μ l concentration are 0.1mol/L calcium chloride solutions,
30 μ l amniotic fluid and 30 μ l urokinases (enzymatic activity of urokinase is 200U/ml) are slowly added into the specimen cup again, are treated
Survey blood sample；
(3) blood sample to be measured is placed in thrombelastogram instrument and tested, obtained Indicators of Fibrinolysis LY30 values, work as LY30
During Zhi≤7.5, the incidence of the amniotic fluid of pregnant woman embolism coagulation disorders is higher, and intervening measure should be taken in advance.
Embodiment 3
The present embodiment provides a kind of method that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, including as follows
Step：
(1) it is sufficiently mixed to activate for 0.4mg/ml kaolin solution and 340 μ l blood samples first with 10 μ l concentration
Blood sample, the time for carrying out the activation is 4min, blood sample after being activated；
(2) blood sample after the activation is added to and filled in the specimen cup that 20 μ l concentration are 0.3mol/L calcium chloride solutions,
10 μ l amniotic fluid and 10 μ l urokinases (enzymatic activity of urokinase is 58U/ml) are slowly added into the specimen cup again, obtain to be measured
Blood sample；
(3) blood sample to be measured is placed in thrombelastogram instrument and tested, as LY30 Zhi≤7.5, the pregnant woman sheep
The incidence of water embolism coagulation disorders is higher, and intervening measure should be taken in advance.
Embodiment 4
The present embodiment provides a kind of method that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, including as follows
Step：
(1) it is sufficiently mixed to activate for 0.2mg/ml kaolin solution and 340 μ l blood samples first with 10 μ l concentration
Blood sample, the time for carrying out the activation is 5min, blood sample after being activated；
(2) blood sample after the activation is added to and filled in the specimen cup that 20 μ l concentration are 0.3mol/L calcium chloride solutions,
10 μ l amniotic fluid and 15 μ l urokinases (enzymatic activity of urokinase is 85U/ml) are slowly added into the specimen cup again, obtain to be measured
Blood sample；
(3) blood sample to be measured is placed in thrombelastogram instrument and tested, as LY30 Zhi≤7.5, the pregnant woman sheep
The incidence of water embolism coagulation disorders is higher, and intervening measure should be taken in advance.
Embodiment 5
The present embodiment provides a kind of method that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, including as follows
Step：
(1) it is that 0.3mol/L kaolin solutions and 340 μ l blood samples are sufficiently mixed to activate blood first with 10 μ l concentration
Sample, the time for carrying out the activation is 5min, blood sample after being activated；
(2) blood sample after the activation is added to and filled in the specimen cup that 20 μ l concentration are 0.2mol/L calcium chloride solutions,
10 μ l amniotic fluid and 20 μ l urokinases (enzymatic activity of urokinase is 120U/ml) are slowly added into the specimen cup again, are treated
Survey blood sample；
(3) blood sample to be measured is placed in thrombelastogram instrument and tested, as LY30 Zhi≤7.5, the pregnant woman sheep
The incidence of water embolism coagulation disorders is higher, and intervening measure should be taken in advance.
Embodiment 6
The present embodiment provides a kind of method that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, including as follows
Step：
(1) it is that 0.4mol/L kaolin solutions and 340 μ l blood samples are sufficiently mixed to activate blood first with 10 μ l concentration
Sample, the time for carrying out the activation is 5min, blood sample after being activated；
(2) blood sample after the activation is added to and filled in the specimen cup that 20 μ l concentration are 0.2mol/L calcium chloride solutions,
10 μ l amniotic fluid and 25 μ l urokinases (enzymatic activity of urokinase is 150U/ml) are slowly added into the specimen cup again, are treated
Survey blood sample；
(3) blood sample to be measured is placed in thrombelastogram instrument and tested, as LY30 Zhi≤7.5, the pregnant woman sheep
The incidence of water embolism coagulation disorders is higher, and intervening measure should be taken in advance.
Experimental example
Clinical practice experimental group (75 Prepartal womens) and clinical practice are compareed using the detection method described in embodiment 3
Group (32 unpregnancy women) is tested really.As a result it is as shown in table 1.
LY30 differences before and after table 1-use amniotic fluid and urokinase induction
From table 1 it follows that before induction, experimental group and LY30≤7.5 (amniotic fluid embolism coagulation disorders in control group
Incidence it is higher) number be respectively 1 people, diversity ratio p between experimental group and control group sample is 0.531, χ2For 0.393, say
The difference before induction is not notable with control group for bright experimental group；After being induced using the μ l urokinases of 10 μ l amniotic fluid+10, experimental group
The number of middle LY30≤7.5 (incidence of amniotic fluid embolism coagulation disorders is higher) is LY30≤7.5 in 22 people, control group
The number of (incidence of amniotic fluid embolism coagulation disorders is higher) is 31 people, the diversity ratio p between experimental group and control group sample
For 0.001, χ2For 40.933, illustrate experimental group and control group difference highly significant after induction.It therefore, it can utilize the present invention
Method filters out the higher pregnant woman of amniotic fluid embolism coagulation disorders incidence, to take intervening measure in advance.
The foregoing is only a specific embodiment of the invention, but protection scope of the present invention is not limited thereto, any
Those familiar with the art the invention discloses technical scope in, change or replacement can be readily occurred in, should all be contained
Cover within protection scope of the present invention.Therefore, protection scope of the present invention should be based on the protection scope of the described claims.
Claims (10)
1. application of the thrombelastogram in prediction amniotic fluid embolism coagulation disorders.
2. a kind of method that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, it is characterised in that including following step
Suddenly：
(1) blood sample is fully activated first with kaolin solution, blood sample after being activated；
(2) blood sample after the activation is added in the specimen cup for filling calcium chloride solution, then slowly added into the specimen cup
Enter amniotic fluid and urokinase, obtain blood sample to be measured；The volume of the calcium chloride solution, amniotic fluid, urokinase and blood sample after the activation
The ratio between be 15-25:5-30:5-30:300-400；
(3) blood sample to be measured is placed in thrombelastogram instrument and tested, obtain Indicators of Fibrinolysis LY30 values.
3. the method according to claim 2 that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, its feature
It is, the activity of the urokinase is 20-200U/ml.
4. the method according to claim 2 that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, its feature
It is, in step (1), kaolin solution is sufficiently mixed to activate blood sample with blood sample, and the time for carrying out the activation is 3-
6min。
5. the method according to claim 2 that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, its feature
It is, in step (1), the concentration of the kaolin solution is 0.2-0.5mg/ml.
6. the method according to claim 5 that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, its feature
It is, the ratio between volume of the kaolin solution and the blood sample is 5:400-15:300.
7. the method according to claim 2 that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, its feature
It is, in step (2), in the specimen cup, the addition of the amniotic fluid is 5-30 μ l.
8. the method according to claim 2 that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, its feature
It is, in step (2), in the specimen cup, the addition of the urokinase is 5-30 μ l.
9. the method according to claim 2 that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, its feature
It is, in step (2), in the specimen cup, the concentration of the calcium chloride solution is 0.1-0.5mol/L.
10. the method according to claim 2 that amniotic fluid embolism coagulation disorders is predicted based on thrombelastogram, its feature
It is, during LY30 Zhi≤7.5, the incidence of amniotic fluid embolism coagulation disorders is high.
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| CN101587063A (en) * | 2009-06-19 | 2009-11-25 | 西安交通大学 | Method for detecting hemostatic capability |
| CN104661582A (en) * | 2012-05-14 | 2015-05-27 | 高斯外科公司 | System and methods for managing blood loss of a patient |
| CN106546743A (en) * | 2016-11-04 | 2017-03-29 | 中山大学 | A kind of real-time monitoring system and monitoring method of amniotic embolism serological index |
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2017
- 2017-08-24 CN CN201710722870.3A patent/CN107300622B/en active Active
Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN101587063A (en) * | 2009-06-19 | 2009-11-25 | 西安交通大学 | Method for detecting hemostatic capability |
| CN104661582A (en) * | 2012-05-14 | 2015-05-27 | 高斯外科公司 | System and methods for managing blood loss of a patient |
| CN106546743A (en) * | 2016-11-04 | 2017-03-29 | 中山大学 | A kind of real-time monitoring system and monitoring method of amniotic embolism serological index |
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| Title |
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| L ZACCHETTI, ET AL.: "Urokinase-induced fibrinolysis in thromboelastography(UKIF-TEG) to assess fibrinolysis in critically ill patients.", 《CRITICAL CARE》 * |
| M.J.GALLIMORE, ET AL.: "Urokinase induced fibrinolysis in thromboelastography: a model for studying fibrinolysis and coagulation in whole blood.", 《JOURNAL OF THROMBOSIS AND HAEMOSTASIS》 * |
| M.J.P.HARNETT, ET AL.: "Effect of amniotic fluid on coagulation and platelet function in pregnancy: an evaluation using thromboelastography.", 《ANAESTHESIA》 * |
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