血栓弹力图在高血压脑出血手术与非手术患者中的改变  

Changes of thrombelastography in surgical and medical patients with hypertensive intracerebral hemorrhage

作　　者：王皓[1] 刘晓琴[1] 何宗钊[1] 陈强[1] 孙斌[1] 杨正平[1] 马四清[1] Wang Hao;Liu Xiaoqin;He Zongzhao;Chen Qiang;Sun Bin;Yang Zhengping;Ma Siqing(Department of Intensive Care Medicine,Qinghai Province People's Hospital,Xining 810007,China)

机构地区：[1]青海省人民医院重症医学科,西宁810007

出　　处：《中华重症医学电子杂志》2021年第2期132-136,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：青海省高原重症医学重点实验室项目(2020-81);青海省科技创新创业项目(高原低氧损害防治研究重症医学创新创业团队)(2020-66);青海省科技厅基础研究计划项目(2019-ZJ-7080);青海省卫生计生系统指导性计划课题(2018-wjzdx-07)。

摘　　要：目的观察血栓弹力图在高血压脑出血手术与非手术治疗患者中的改变。方法回顾性收集我院2016年5月至2018年6月间收治的高血压脑出血患者131例。根据是否手术分为手术组与非手术组,并选取门诊体检的17例健康志愿者作为正常对照组。非手术组与手术组患者治疗前后均检测血栓弹力图,正常对照组只做当日体检时的血栓弹力图。比较三者血栓弹力图指标的差异。结果治疗前3组间两两组间比较,治疗后手术组与正常对照组、手术组与非手术组组间比较,治疗前后手术组与非手术组组内比较,凝血反应时间(R)、血凝块形成时间(K)、血细胞凝集块形成速率(a角)、最大血块强度(MA)、凝血指数(CI)差异均有统计学意义(P<0.05);治疗后非手术组与正常对照组组间R、MA分别比较,差异均有统计学意义(P<0.05)。入院时的出血量与CI、CI与手术治疗患者的总出血量均呈负相关(r=−0.618,P=0.001;r=−0.666,P=0.001)。入院时出血量与CI值、入院时CI值与手术治疗患者的总出血量、入院时出血量与治疗后CI值均呈负相关(r=−0.618,P=0.001;r=−0.666,P=0.001;r=−0.697,P=0.001);手术治疗患者的总出血量与治疗后CI值无相关关系(r=−0.038,P=0.760)。结论高血压脑出血患者的凝血因子,凝血块形成的速度,纤维蛋白水平及血小板功能均发生异常。患者经手术或非手术治疗后存活患者的上述指标较入院时好转,但手术组的血栓弹力图指标较非手术组明显异常,这可能与手术组患者脑出血量多,病情严重有关。Objective To understand the changes of thrombelastography in surgical and medical patients with hypertensive intracerebral hemorrhage.Methods The clinical data of 131 hypertensive intracerebral hemorrhage patients were retrospectively collected in our hospital from May 2016 to June 2018.Patients were divided into the surgical group and medical group according to whether received operation or not.Seventeen healthy volunteers who underwent physical check-ups were selected as the control group.All the patients were tested by thrombelastography before and after treatment.The control group was only tested once when underwent physical check-ups.The results of thrombelastography in the three group were compared.Results Before treatment,R value,K value,a angle,MA value and CI value were significantly different among three groups as well as different in each two group comparisons(P<0.05).Similar results were found after treatment except K value,a angle,CI value between non-surgical group and normal control group.Significant differences of the R value,K value,a angle,MA value and CI value were found between before and after treatment in both surgical and medical group(P<0.05).There was a negative correlation between the blood loss and the CI at admission(r=−0.618,P=0.001),the CI at admission and total blood loss in patients undergoing surgical treatment(r=−0.666,P=0.001),the blood loss at admission and post-treatment CI(r=−0.697,P=0.001).Total bleeding in patients undergoing surgical treatment had no association with post-treatment CI(r=−0.038,P=0.760).Conclusion Patients with hypertensive intracerebral hemorrhage had abnormal clotting factors,clot formation rate,fibrin and platelet function.The indicators of both surgical and medical patients improved after treatment.

关 键 词：血栓弹力图 脑出血 高血压 

分 类 号：R651.12[医药卫生—外科学]