动脉瘤性蛛网膜下腔出血急性期深静脉血栓形成与凝血因子功能亢进的关系研究  

Deep vein thrombosis in aneurysmal subarachnoid hemorrhage at acute stage is associated with hyperfunction of coagulation factors

作　　者：苗旺[1] 王蕾[2] 师云波[1] 岳培建[1] 赵珂 荆婧[1] 黄培培[1] 张丽娜[1] 李东瑞[1] 张书语 滕军放[1] Miao Wang;Wang Lei;Shi Yunbo;Yue Peijian;Zhao Ke;Jing Jing;Hang Peipei;Zhang Lina;Li Dongrui;Zhang Shuyu;Teng Junfang(Neuro-Intensive Care Unit,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Otolaryngology,Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Neuro-Intensive Care Unit,First People's Hospital of Pingdingshan City,Pingdingshan 467000,China)

机构地区：[1]郑州大学第一附属医院神经重症科,郑州450052 [2]郑州大学第二附属医院耳鼻喉科,郑州450003 [3]河南省平顶山市第一人民医院神经重症科,467000

出　　处：《中华神经医学杂志》2020年第6期576-581,共6页Chinese Journal of Neuromedicine

基　　金：河南省高等学校重点科研项目(17A320067)。

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血(aSAH)急性期(1周内)凝血因子的变化规律及其与深静脉血栓形成(DVT)的关系。方法选择郑州大学第一附属医院神经重症科自2015年3月至2019年3月收治的202例aSAH患者(aSAH组),发病后第1、3天根据患者是否合并DVT,将其分为合并DVT组和未合并DVT组。另外选择100例年龄和性别与aSAH组患者相匹配的健康体检者作为对照组,于aSAH患者发病后第1、3、5、7天,对照组入组第1天采用血栓弹力图(TEG)检测受试者TEG的R值(TEG-R)。aSAH患者发病后第1、2、3、4、5、6、7天采用四肢彩色多普勒超声检查确定有无DVT。结果aSAH急性期共73例(36.14%)患者合并DVT。其中无症状性血栓患者66例,症状性血栓患者7例;下肢肌间静脉血栓59例,肌间合并其他深静脉血栓14例。发病后第1~3天合并DVT 68例(93.20%),是DVT的高峰期。发病后第1、3天,aSAH组患者的TEG-R低于对照组,差异有统计学意义(P<0.05);发病后第1、3天aSAH组患者的TEG-R低于发病后第5、7天,差异有统计学意义(P<0.05)。发病后第1、3天,合并DVT组患者的TEG-R均低于未合并DVT组,差异均有统计学意义(P<0.05)。结论aSAH发病后第1~3天内凝血因子功能增强,DVT发生率最高,以无症状性的肌间静脉血栓为主;是否合并DVT与凝血因子功能亢进有关。Objective To explore the changes of levels of coagulation factors at acute phase(within one week)of aneurysmal subarachnoid hemorrhage(aSAH)and their relations with deep venous thrombosis(DVT).Methods Two hundred and two aSAH patients(aSAH group),admitted to our hospitals from March 2015 to March 2019,were selected in our study,and these patients were divided into a combined DVT subgroup and a uncombined DVT subgroup according to whether they were combined with DVT on the first and third d of onset.One hundred healthy physical examiners whose age and gender matched with those of aSAH group were selected as control group;one,3,5,and 7 d after onset,and one d after enrolling of subjects from the control group,thromboelastogram(TEG)was used to detect the R value of TEG(TEG-R)in all subjects.One,two,3,4,5,6 and 7 d after onset,color Doppler ultrasonography was used to determine whether aSAH patients had DVT.Results A total of 73 patients(36.14%)were combined with DVT at acute stage of aSAH;66 were with asymptomatic thrombosis and 7 with symptomatic thrombosis;59 were with lower extremity intermuscular vein thrombosis and 14 were with intermuscular vein thrombosis.The incidence of DVT(68/73[93.2%])peaked on the 1st-3rd d of onset.The TEG-R of patients in aSAH group was statistically lower than that of the control group on the 1st-3rd d of onset(P<0.05);the TEG-R of patients in aSAH group on the 1st-3rd d of onset was significantly lower than that on 5th and 7th d of onset(P<0.05).The TEG-R of patients in combined DVT subgroup was significantly lower than that of the uncombined DVT subgroup(P<0.05).Conclusions Hyperfunction of coagulation factors at acute stage of aSAH is noted within one-3 d of onset;the incidence of DVT is the highest within 3 d of onset,mainly featured as asymptomatic intermuscular venous thrombosis.Whether or not aSAH would combine with DVT is associated with hyperfunction of coagulation factors.

关 键 词：动脉瘤性蛛网膜下腔出血 深静脉血栓形成 血栓弹力图 凝血功能 

分 类 号：R743.35[医药卫生—神经病学与精神病学]