血栓弹性图监测二磷酸腺苷途径诱导的血小板功能障碍与创伤性脑损伤患者院内病死率的相关性研究  

Relationship between adenosine diphosphate pathway-induced platelet dysfunction monitoring by thrombelastography with hospital mortality in patients with traumatic brain injury

作　　者：杨秋林[1] 吴锋[1] 张小文 吴彬彬 徐郁颖 张晶[1] Yang Qiulin;Wu Feng;Zhang Xiaowen;Wu Binbin;Xu Yuying;Zhang Jing(Intensive Care Unit,Zhejiang Quhua Hospital,Zhejiang Quzhou 324000,China)

机构地区：[1]浙江衢化医院ICU,浙江衢州324000

出　　处：《中国医师进修杂志》2020年第7期614-618,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨血栓弹性图监测二磷酸腺苷(ADP)途径诱导的血小板功能障碍与创伤性脑损伤患者院内病死率的相关性研究。方法回顾性分析浙江衢化医院2016年1月至2018年12月180例创伤性脑损伤患者的临床资料。患者均行血栓弹力图检查,其中ADP途径诱导的血小板抑制率(ADP抑制率)≤60%为非ADP功能障碍组(74例),ADP抑制率>60%为ADP功能障碍组(106例)。多元Logistic回归分析患者院内病死率的独立影响因素,采用Logistic回归模型分析ADP抑制率预测院内病死率的阈值。结果两组性别构成、年龄、凝血酶原时间、国际标准化比率、活化部分凝血活酶时间、血小板计数、收缩压、脉搏、入院到血栓弹力图检查时间、格拉斯昏迷评分、创伤严重度评分、简易创伤定级标准及入院前抗血小板药物使用情况比较差异无统计学意义(P>0.05);ADP功能障碍组入院后插管率和院内病死率明显高于非ADP功能障碍组[69.8%(74/106)比37.8%(28/74)和32.1%(34/106)比8.1%(6/74)],差异有统计学意义(P<0.01或<0.05)。ADP功能障碍组最大振幅和G值明显低于非ADP功能障碍组[(61±9)mm比(65±6)mm、(9±4)kD/cm^2比(11±3)kD/cm^2],ADP抑制率和花生四烯酸途径诱导的血小板抑制率明显高于非ADP功能障碍组[(76±22)%比(45±18)%和(75±28)%比(35±22)%],差异有统计学意义(P<0.05);两组反应时间、血凝块形成时间和角度比较差异无统计学意义(P>0.05)。多元Logistic回归分析结果显示,ADP抑制率>60%和创伤严重度评分是创伤性脑损伤患者院内病死率增加的独立预测因素(OR=6.21和1.13,95%CI 1.21~31.27和1.05~1.22,P<0.05)。Logistic回归模型分析结果显示,ADP抑制率>60%是预测患者院内病死率的阈值(OR=6.18,95%CI 1.2~33.3)。结论血栓弹力图中的ADP抑制率与创伤性脑损伤患者的院内病死率有关。Objective To investigate the relationship between adenosine diphosphate(ADP)pathway-induced platelet dysfunction monitoring by thrombelastography with hospital mortality in patients with traumatic brain injury.Methods The clinical data of 180 patients with traumatic brain injury in Zhejiang Quhua Hospital from January 2016 to December 2018 were retrospectively analyzed.The patients underwent thrombelastography examination.Among them,the ADP pathway-induced platelet inhibition rate(ADP inhibition rate)≤60%was in 74 cases(non-ADP dysfunction group),and ADP inhibition rate>60%was in 106 cases(ADP dysfunction group).Multiple Logistic regression analysis was used to analyze the independent influencing factors of patients′hospital mortality.Logistic regression model was used to analyze the threshold of ADP inhibition rate to predict hospital mortality.Results There were no statistical differences in the gender composition,age,prothrombin time,international standardized ratio,activated partial thromboplastin time,platelet count,systolic blood pressure,pulse,admission to thrombelastography examination time,Glasgow coma score,trauma severity score,simple trauma grading criteria and using of antiplatelet drugs before admission between 2 groups(P>0.05).The intubation rate and in-hospital mortality in ADP dysfunction group were significantly higher than those in non-ADP dysfunction group:69.8%(74/106)vs.37.8%(28/74)and 32.1%(34/106)vs.8.1%(6/74),and there were statistical differences(P<0.01 or<0.05).The maximum amplitude and G value in ADP dysfunction group were significantly lower than those in non-ADP dysfunction group:(61±9)mm vs.(65±6)mm and(9±4)kD/cm^2 vs.(11±3)kD/cm^2,the ADP inhibition rate and arachidonic acid pathway-induced platelet inhibition rate were significantly higher than those in non-ADP dysfunction group:(76±22)%vs.(45±18)%and(75±28)%vs.(35±22)%,and there were statistical differences(P<0.05).There were no statistical difference in the reaction time,blood clot formation time and angle between 2

关 键 词：脑损伤 血栓弹力描记术 腺苷二磷酸 血小板功能障碍 

分 类 号：R651.15[医药卫生—外科学] R558[医药卫生—临床医学]