血栓弹力图预测颅脑创伤病人术后预后不良的临床价值  

The Value of Thrombelastography in Predicting the Poor Prognosis of Patients after Traumatic Brain Injury

作　　者：何俊[1] 杜琴 龚浩[1] 温江[1] 魏平波[1] HE Jun;DU Qin;GONG Hao;WEN Jiang;WEI Pingbo(Mianzhu People′s Hospital/Mianzhu Hospital,West China Hospital,Mianzhu 618200,Sichuan,China)

机构地区：[1]绵竹市人民医院/华西医院绵竹医院,四川绵竹618200

出　　处：《中西医结合心脑血管病杂志》2021年第17期3012-3015,共4页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：四川省卫生健康委员会科研课题(No.19PJ220)。

摘　　要：目的探讨血栓弹力图(TEG)对颅脑创伤(TBI)病人术后预后不良的预测价值。方法回顾性分析2015年9月—2019年9月绵竹市人民医院收治的92例TBI病人的临床资料,根据其术后28 d预后结局分为死亡组(21例)和存活组(71例),比较两组病人的一般资料以及凝血指标,并利用受试者工作特征曲线(ROC)评估TEG指标和传统凝血六项指标对TBI病人术后28 d死亡的预测价值。结果存活组瞳孔对光反应、格拉斯哥昏迷量表(GCS)评分及凝血功能异常发生率与死亡组比较差异均有统计学意义(P<0.05或P<0.01);存活组入院时国际标准化比值(INR)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)水平均低于死亡组,血小板计数(PLT)、纤维蛋白原(FIB)水平高于死亡组,差异均有统计学意义(P<0.05或P<0.01);存活组术前反应时间(r值)、凝固时间(K值)水平高于死亡组,凝固角(α角)、血栓最大幅度(MA值)、凝血时间(CI)水平低于死亡组,差异均有统计学意义(P<0.05或P<0.01);ROC曲线分析结果显示,TEG检测和传统凝血六项指标联合检测预测TBI病人死亡的AUC分别为0.935、0.860,差异有统计学意义(Z=2.707,P=0.007)。结论检测凝血指标对预测TBI病人术后28 d预后有积极意义,TEG凝血指标的预测效能高于传统凝血六项指标。Objective To study the predictive value of thrombelastography(TEG)on poor prognosis of patients after traumatic brain injury(TBI).Methods A retrospective analysis was performed based on the clinical data of 92 TBI patients,at postoperative 28 d prognosis outcomes,the patients were divided into death group(n=21)and survival group(n=71).The general data and coagulation indexes were compared between two groups.The predictive value of TEG and traditional coagulation indexes in postoperative 28 d death of TBI patients was evaluated by receiver operating characteristic(ROC)curves.Results There were significant differences in light response,score of Glasgow Coma Scale(GCS),and incidence of coagulation disorders between survival group and death group(P<0.05 or P<0.01).The international normalization ratio(INR),prothrombin time(PT),activated partial thromboplastin time(APTT),and D-dimer(D-D)level at admission in survival group were lower than those in death group,while the levels of platelet count(PLT)and fibrinogen(FIB)in surrival group were higher than those in death group(P<0.05 or P<0.01).The preoperative reaction time(R value)and clotting time(K value)in survival group were higher than those in death group,while coagulation angle(αangle),maximum thrombus amplitude(MA value),and coagulation time(CI)in surrival group were lower than those in death group(P<0.05 or P<0.01).The Results of ROC curve analysis showed that area under the curve(AUC)of TEG indexes and traditional coagulation indexes for predicting death of TBI patients were 0.935,0.860,respectively.The differences in AUC between two groups were statistically different(Z=2.707,P=0.007).Conclusion The coagulation index provide positive significance in predicting postoperative 28 d prognosis of TBI patients.The predictive efficiency of TEG coagulation indexes is higher than that of traditional six items of blood coagulation.

关 键 词：颅脑创伤 凝血功能障碍 血栓弹力图 凝血功能 纤维蛋白原 

分 类 号：R651.15[医药卫生—外科学]