摘要
目的 分析血栓弹力图及凝血功能检测联合预测外伤后进展性颅内出血(Progressive Hemorrhagic Injury,PHI)的临床价值。方法 回顾性选取2016年1月—2022年8月梧州市人民医院神经外科诊治的141例创伤性颅内出血患者的临床资料,根据是否存在进展性颅内出血将患者分为A组和B组。A组(71例)为存在进展性颅内出血的患者,B组(70例)为无进展性颅内出血的患者。入院时对两组患者均进行检测凝血功能、血栓弹力图及头颅CT检查,记录患者的各项指标。入院后72 h复查头颅CT比较两组患者颅内出血的变化,比较两组患者出院后3个月的复查结果。结果 Logistic回归分析结果显示,D-二聚体(D-Dimer,D-D)、凝血酶时间(Thrombin Time,TT)、凝血反应时间(Reaction Time,R)、血栓最大振幅(MA值)为早期脑出血患者再出血的影响因素,其中D-D、TT、R时间、MA值为发生PHI的危险因素(OR=2.744、1.716、12.992、1.635,P均<0.05)。ROC曲线评估上述相关指标的预测效能,D-D、TT、R时间、MA值对预测患者进展性颅内出血的AUC分别为0.946、0.800、0.978、0.964(P均<0.05)。结论 D-D、TT、R时间、MA值为创伤性脑损伤患者发生PHI的影响因素。因此,血栓弹力图及凝血功能测定有效预测进展性颅内出血发生的概率,对于D-D、TT、R时间延长与MA数值较低的患者应警惕颅内再次出血的发生。
Objective To analyze the clinical value of the combination of thrombelastogram and coagulation function test in predicting progressive hemorrhagic injury(PHI) after trauma.Methods The clinical data of 141 patients with traumatic intracranial hemorrhage treated in the Department of Neurosurgery of Wuzhou People's Hospital from January 2016 to August 2022 were retrospectively selected,and the patients were divided into group A and group B according to whether there was progressive intracranial hemorrhage.Group A(71 cases) included patients with progressive intracranial hemorrhage,and group B(70 cases) included patients without progressive intracranial hemorrhage.At admission,the coagulation function,thromboelastography and head CT examination were performed in both groups,and various indicators of the patients were recorded.Head CT was reviewed 72 h after admission to compare the changes of intracranial hemorrhage between the two groups,and the results were compared 3 months after discharge.Results Logistic regression analysis showed that D-dimer(D-D),thrombin time(TT),reaction time(R) and platelet aggregation function(MA value) were the influencing factors for rebleeding in early intracerebral hemorrhage patients,among which D-D,TT,R time and MA value were the risk factors for the occurrence of PHI(OR=2.744,1.716,12.992,1.635,all P<0.05).ROC curve evaluated the predictive efficacy of the above related indicators,and the AUC of DD,TT,R time and MA value in predicting patients with progressive intracranial hemorrhage was 0.946,0.800,0.978and 0.964,respectively(all P<0.05).Conclusion D-D,TT,R time and MA value were the influencing factors of PHI occurrence in patients of traumatic brain injury.Therefore,thrombologram and coagulation function measurement can effectively predict the probability of progressive intracranial hemorrhage,and patients with prolonged D-D,TT,R time and low MA value should be vigilant about the occurrence of intracranial rehemorrhage.
作者
张焕威
李荣卓
江南凯
欧嘉华
李朝科
黄常坚
ZHANG Huanwei;LI Rongzhuo;JIANG Nankai;OU Jiahua;LI Chaoke;HUANG Changjian(Department of Neurosurgery,Wuzhou People's Hospital,Wuzhou,Guangxi Zhuang Autonomous Region,543003 China)
出处
《系统医学》
2024年第4期18-22,共5页
Systems Medicine
基金
梧州市科技计划项目(201902177)
右江民族医学院科研课题项目(yy2019ky019)。
关键词
血栓弹力图
凝血功能
创伤
颅内进展性出血
Thrombelastogram
Coagulation function
Trauma
Progressive intracranial hemorrhage
