血栓弹力图对重症颅脑损伤手术患者预后预测价值的研究  

Value of thromboelastography in evaluating prognosis with severe craniocerebral surgery injury patients

作　　者：吴依娜[1] 段军[1] 梁杰佳 侯佳彤 李刚[1] Wu Yina;Duan Jun;Liang Jiejia;Hou Jiatong;Li Gang(Department of surgical intensive critical medicine,China-Japan Friendship Hospital,Beijing,China)

机构地区：[1]中日友好医院外科重症医学科

出　　处：《实用休克杂志（中英文）》2020年第2期96-100,共5页Journal of Practical Shock

基　　金：国家自然科学基金(项目编号:81700260)。

摘　　要：目的探讨血栓弹力图对重症颅脑损伤手术患者预后的预测价值。方法根据患者术后28d预后情况,选取2018年1月至2019年12月入住中日友好医院外科重症医学科(SICU)的66例颅脑手术术后患者,分为存活组(44例)和死亡组(22例)。比较两组患者的基线资料、实验室指标、用药详情和疾病严重程度评分,包括急性生理与慢性健康评分(APACHEⅡ评分)、格拉斯哥昏迷评分(GCS),以及血栓弹力图各指标,包括凝血反应时间(R值),血凝块形成时间及速率(K值),血凝块生成率(α角),血凝块最大强度和硬度(MA值),通过多因素COX回归探讨血栓弹力图对颅脑损伤术后患者28d死亡的影响因素。结果死亡组患者在APACHEⅡ评分、血管活性药应用、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白(原)降解产物(FDP)上明显高于存活组;GCS评分、血小板计数均明显低于存活组。死亡组中血栓弹力图R值、K值较存活组均明显延长,而α角、MA值较存活组均显著降低。血栓弹力图各指标与凝血功能指标均存在相关性,多因素COX回归结果提示:APACHEⅡ评分{HR=1.127,95%CI(1.059,1.198),P=0.03},血栓弹力图中MA值<50mm{HR=3.502,95%CI(1.818,12.142),P=0.04},为重症颅脑损伤患者术后28d死亡的影响因素。结论APACHEⅡ评分和血栓弹力图MA值降低对重症颅脑手术患者28d预后具有一定的预测价值。Objective To explore the prognostic value of thromboelastography in patients with severe craniocerebral injury.Methods According to the prognosis of patients 28days after operation,66patients admitted to SICU of China-Japan Friendship Hospital from January 2018to December 2019 were divided into survival group(44cases)and death group(22cases).Baseline data,laboratory parameters,medication details and disease severity scores,including acute physiological and chronic health scores(APACHEⅡ),Glasgow Coma Score and various indexes of thromboelastography,including coagulation reaction time(R value),clot formation time and rate(K value),clot formation rate(α angle),maximum strength and hardness of clot(MA value)were compared between the two groups.Multivariate Cox regression analysis was used to evaluate the prognostic of each index on patients with craniocerebral injury.Results The APACHEⅡscore,the use of vasoactive drugs,prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen degradation products(FDP)were significantly higher in the death group than in the survival group,and the GCS score and platelet count were significantly lower than in the survival group.The R and K values in the death group were significantly longer,while theαangle and MA values were significantly lower.The results of Cox regression showed that:APACHEⅡ score{HR=1.127,95%CI(1.059,1.198),P=0.03},MA value<50mm{HR=3.502,95%CI(1.818,12.142),P=0.04}were the influencing factors of 28days survival rate.Conclusions The APACHEⅡ score and the decrease of MA value in thromboelastography has a certain predictive value for the prognosis of severe craniocerebral surgery patients at 28days.

关 键 词：血栓弹力图 MA值 APACHEⅡ评分 凝血功能 重症颅脑损伤 

分 类 号：R651.15[医药卫生—外科学]