aSAH后早期凝血功能变化与迟发性脑缺血的相关性研究  

Correlation between the early coagulation function and delayed cerebral ischemia after aSAH

作　　者：毛磊 苑玉清[2] 程崇杰[1] 吴精川 柴伟娜[1] 蒋登志 张晓冬[1] 孙晓川[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016 [2]成都市第三人民医院神经外科,成都610031

出　　处：《重庆医科大学学报》2017年第12期1631-1634,共4页Journal of Chongqing Medical University

基　　金：国家自然科学基金面上资助项目(编号:81571159)

摘　　要：目的:探讨动脉瘤性蛛网膜下腔出血(aneurysmalsubarachnoid hemorrhage,aSAH)后早期凝血功能各参数变化与迟发性脑缺血(delayed cerebral ischemia,DCI)的相关性,为临床上早期预测及干预迟发性脑缺血提供依据。方法:回顾性分析77例aSAH患者发病24 h内的凝血象和血栓弹力图(thromboelastography,TEG)参数,同期收集22例未破裂动脉瘤(unruptured intracranial aneurysm,UIA)患者作为对照。根据是否发生DCI将aSAH患者分为DCI组(n=38)和No-DCI组(n=39),比较2组间一般资料、凝血象和TEG参数的差异,多因素logistic回归分析确定危险因素。结果:与No-DCI组比较,DCI组患者D-D、FDP、Fib、α角、MA值明显升高(P=0.000、0.000、0.000、0.043、0.042),R和K值明显降低(P=0.002、0.036);多因素分析显示D-D(OR=9.739,95%CI=1.896~50.042,P=0.006)、K值(OR=0.026,P=0.028,95%CI=0.01~0.681)为DCI的独立危险因素。结论:aSAH患者早期D-D、FDP、Fib、α角、MA值明显升高,R、K值下降,与DCI的发生存在相关性,其中D-D与K值为aSAH后发生DCI独立危险因素。因此,早期监测凝血功能有助于预测DCI的发生,并指导相应处理。Objective：To investigate the correlation between the parameter of early coagulation function and the incidence of delayed cerebral ischemia after subarachnoid hemorrhage and to provide basis of early prediction and intervention for delayed cerebral ischemia in clinical treatment.Methods：The coagulation and TEG of 77 patients with aSAH within 24 hours from onset was analyzed retrospectively and 22 cases of unruptured aneurysms（UIA）were collected as matched group.aSAH patients were divided into the DCI group（38 cases）and No-DCI group（39 cases）to compare the clinical data,coagulogram and parameter of TEG.The multi-factor logistic regression analysis was adopted to determine the risk factors.Results：Compared with those of the No-DCI group,the values of DD,FDP,Fib,α and MA in DCI group were significantly higher（P=0.000,0.000,0.000,0.043,0.042）,while values of R and K were lower（P=0.002,0.036）.The result of multiple-factor analysis shows that the parameter of D-D and K were the independent risk factors.Conclusion：The parameter of D-D,FDP,Fib,α angle,MA is significantly increased,while the parameter of R and K is significantly decreased in aSAH.D-D and K are independent risk factors of DCI.Therefore,early monitoring of coagulation function can help predict the occurrence of DCI,as well as guide the therapies.

关 键 词：蛛网膜下腔出血 迟发性脑缺血 凝血象 血栓弹力图 

分 类 号：R651.1[医药卫生—外科学]