D-二聚体、血钾及血栓弹力图参数与脑外伤后进展性出血性损伤的关联性  

Correlation of D-dimer, serum potassium and thromboelasto-graphy parameters with progressive hemorrhagic injury

作　　者：蒋先孝 聂见云 杨劲[1] JIANG Xianxiao;NIE Jianyun;YANG Jin(Department of Blood Transfusion,the Second People's Hospital of Hefei,Hefei 230011,China)

机构地区：[1]合肥市第二人民医院输血科,安徽合肥230011

出　　处：《中国输血杂志》2022年第10期1035-1040,共6页Chinese Journal of Blood Transfusion

基　　金：合肥市第二人民医院院级课题(2022yyb015)。

摘　　要：目的 探讨D-二聚体、血钾及血栓弹力图参数与脑外伤后进展性出血性损伤(PHI)的关联性。方法 收集2018年1月~2021年5月本院209例创伤性颅脑损伤(TBI)患者资料进行分析,根据CT扫描复查总出血病灶是否增加25%,分为PHI组(161例)和非PHI(48例)。采用单因素分析和多因素Logistic回归分析发生PHI的危险因素,运用受试者工作曲线(ROC)分析D-二聚体、血钾和血栓弹力图(TEG)参数单独、联合指标与PHI的关联性。结果 209例TBI患者,23.0%(48例)发生PHI。单因素分析两组间,GCS评分、年龄、对光发射、收缩压、血钾、血钙、血糖、R值、PT、APTT、INR、D-二聚体、蛛网膜出血、硬膜下血肿、脑挫伤、中线位置的差异均有统计学意义(P<0.05)。多因素Logistic分析确定5个独立危险因素(P<0.05):D-二聚体≥3.52μg/mL、血钾<3.70 mmol/L、R值≥5.65 min、硬膜下血肿、脑挫伤。根据独立危险因素构建预测发生PHI模型,D-二聚体+血钾+R值+硬膜下血肿+脑挫伤联合检测曲线下面积(AUC)最大为0.889 9。结论 D-二聚体≥3.52μg/mL、血钾<3.70 mmol/L、R值≥5.65 min、硬膜下血肿、脑挫伤是影响TBI患者是否发生PHI的重要因素。Objective To investigate the correlation between D-dimer, serum potassium and thromboelastography parameters and progressive hemorrhagic injury(PHI) after brain injury. Methods The data of 209 patients with traumatic brain injury(TBI) in our hospital from January 2018 to May 2021 were collected and analyzed. The patients were divided into PHI group(161 cases) and non-PHI group(48 cases) according to CT scan whether the total bleeding lesions had increased by 25%. Univariate analysis and multivariate Logistic regression were used to analyze the risk factors of PHI, and receiver operating curve(ROC) was used to analyze the predictive value of D-dimer, serum potassium and thromboelastography(TEG) parameters used alone and in combination. Results PHI occurred in 48(23.0 %) out of 209 TBI patients. In univariate analysis, there were statistically significant differences in GCS score, age, light emission, systolic blood pressure, serum potassium, blood calcium, blood glucose, R value, PT, APTT, INR, D-dimer, arachnoid hemorrhage, subdural hematoma, cerebral contusion and midline location between the two groups(P<0.05). Five independent risk factors were determined by multivariate Logistic analysis(P<0.05): D-dimer ≥3.52 μg/mL, serum potassium <3.70 mmol/L, R value ≥5.65 min, subdural hematoma and cerebral contusion. PHI model was constructed according to independent risk factors, and the maximum area under the curve(AUC) of D-dimer plus serum potassium plus R value plus subdural hematoma plus cerebral contusion was 0.889 9. Conclusion D-dimer ≥3.52 μg/mL, serum potassium <3.70 mmol/L, R value ≥5.65 min, subdural hematoma and cerebral contusion are significant influences for PHI occurrance in TBI patients.

关 键 词：创伤性颅脑损伤 进展性出血性损伤 D-二聚体 血钾 R值 

分 类 号：R651.15[医药卫生—外科学] R457.1[医药卫生—临床医学]