经颅多普勒超声联合血小板计数对外伤后脑梗死发生的预测作用

Predictive effect of transcranial Doppler ultrasonography combined with platelet counting for posttraumatic cerebral infarction

目的探讨颅脑损伤后大脑中动脉平均血流速度(VmMCA)、肘静脉血小板计数(PLT计数)与外伤性脑梗死发生的关系。方法回顾分析2010年6月至2012年1月符合纳入标准的颅脑损伤保守治疗患者387例临床资料,包括患者伤后1、2、3、5、7 d和14 d对患者行TCD检查测量所得的VmMCA值,同时采集患者肘静脉血测量所得的PLT计数,伤后24 h患者格拉斯哥昏迷评分(GCS评分)分值。将伤后治疗过程中14 d内发生脑梗死的患者列为梗塞组,14 d内未出现脑梗死者列为对照组。如果梗塞组患者于14 d内某时刻出现了脑梗死则将不再继续测量比较,剩余患者(最终在14 d内某时刻均已发生脑梗死)继续与对照组进行比较。回顾性研究梗塞组、对照组患者入院后14 d内各时段(1、2、3、5、7 d和14 d)测量所得的VmMCA、PLT计数,分析外伤性脑梗死(posttraumatic cerebral infarction,PTCI)与伤后各时段Vm MCA、PLT计数之间的关系,研究两者及两者结合对外伤性脑梗死发生的预测作用,以及伤后第1天VmMCA、PLT计数与伤情严重程度(GCS评分)关系。结果梗塞组VmMCA较对照组快(Z=-5.302,P<0.01),梗塞组PLT计数较对照组低(Z=-6.702,P<0.01),伤后第1天的VmMCA值越高,PLT计数越低,GCS越低,伤情越重。结论颅脑损伤后VmMCA增高、PLT计数降低与伤后脑梗死的发生有一定的联系,将两者联合对外伤后脑梗死的发生有早期预测作用,伤后1 dVm MCA、PLT计数对伤情严重程度有评估作用。

Objective To explore the relationship of average middle cerebral artery blood flow velocity （VmMCA） and elbow vein blood platelet （PLT） count with incidence of possttraumatic cerebral infarction （PTCI）. Methods We performed a retrospective analysis with the standard clinical data of 387 patients having craniocerebral injury and conservative treatment from June 2010 to January 2012, including VmMCA values of transcranial Doppler ultrasonography （TCD） examination and venous blood PLT count at 1, 2, 3, 5, 7 and 14 d after injury as well as a Glasgow coma scale （GCS） score 24 h after injury. The patients who suffered from cerebral infarction within 14 d were divided into an infarction group, and the patients who did not suffer from cerebral infarction within 14 d into a control group. In the infarction group, the patients suffering from cerebral infarction were rejected on measurement, and the remaining patients were compared with the control patients. The relationship of PTCI with VmMCA and PLT count at 1, 2, 3, 5, 7 and 14 d after injury was analyzed. The relationship of the GCS score with VmMCA and PLT count at 1 d after injury was also analyzed. Results VmMCA of the infarction group was higher than that of the control group at each time point （Z=-5.302, P〈0.01）, while the PLT count of the infarction group was lower （Z=-6.702, P〈0.01）. One day after injury, higher VmMCA value was accompanied by lower PLT count, lower GCS score, and more serious injury degree. Conclusion The increase of VmMCA and decrease of PLT count after injury have relationship with the occurrence of PTCI. Combining VmMCA and PLT count has an early prediction effect for posttraumatic cerebral infarction. The VmMCA and PLT count 1 d after injury are useful for prediction of the injury severity.