脑外伤后血液流变学变化的相关因素分析

Analysis of the relative factors effecting hemorheological changes following head injury

目的 进一步分析颅脑损伤后影响血液流变学改变的诸多相关因素及其变化规律，为临床治疗提供依据。方法 选８６ 例颅脑损伤的病人，进行血液流变学指标的测定并将测定结果分别与格拉斯哥（ＧＣＳ）评分及住院时间等进行相关分析。并观察止血药应用与否，高颅压有无对血液流变学指标的影响。结果 红细胞压积（Ｈｃｔ），血小板黏附率（ＰＡＲ） ，体外血栓长度（ＥＴＬ）ＧＣＳ有显著相关性（ Ｐ＜０－０５）。各项指标变化均与病程长短无关。用止血药组与未用组之间的各项血液流变学指标无显著差异（Ｐ＞０－０５）。有高颅压征患者比无高颅压患者在全血比粘度高切变率（ηＢｈ） 和低切变率（ηＢｌ）、血浆比粘度（ηＰ）、Ｈｃｔ 等指标上改变明显，其统计结果分别为Ｐ＜０－０１、Ｐ＜０－０１ 、Ｐ＜０－０５ 和Ｐ＜０－０１ 。结论 颅脑损伤以后继发多项血液流变学指标的改变，其改变与病情的严重程度密切相关，与病程长短无关，有高颅压的病人改变明显。强调密切监测血液流变学变化，及时纠正异常是十分重要的，同时应注意急性期后的血液流变学改变。

Objective Further to study the relative factors effecting hemorheological changes following head injury for clinical treatment of the patients.Methods Totally 86 cases with head injury were selected for the tests of some hemorheological indexes.All results obtained were used for the relative analysis with glasgow coma scale(GCS) score and course of disease separately.Moreover,the hemostatic drug and intracranial pressure's effects on the hemorheological indexes were observed.Results Of the hemorheological indexes,hematocrit(Hct),platelet adhesion rate (PAR) and external thrombus length(ETL) showed significant correlation with GCS ( P <0 05).All hemorheological indexes had no relation with course of disease.Every index in dicynone group had no significant difference from that in control group ( P >0 05).To compare with those of patients without intracranial hypertension,Whole blood adhesion of high shear stree (ηBh) and low shear stress (ηBl),plasma adhesion(ηP) and Hct of the patients with intracranial hypertension showed significant changes with a statistical result of P <0 01, P <0 01, P <0 05 and P <0 01 respectively.Conclusions Many hemorheological indexes would change follow head injury.The changes of hemorheological indexes were consistent with GCS and intracranial hypertension.Thus,to improve hemorheological condition,relieve its cause and intracranial hypertension were important. [