以优化凝血为导向个体化治疗阿司匹林相关性脑出血

Individualized treatment of aspirin related intracerebral hemorrhage for optimized coagulation

目的探讨阿司匹林相关性脑出血患者的临床特点及个体化治疗策略。方法回顾性分析83例阿司匹林相关性脑出血患者和55例未服用阿司匹林的脑出血患者的临床资料。将阿司匹林相关脑出血患者以是否进行血栓弹力图检测,分为以优化凝血功能的个体化治疗组(41例)和普通治疗组(42例)。比较各组患者血栓弹力图、手术方式、再出血、3个月时的GOS评分。结果入院时血栓弹力图检测血小板功能,个体化治疗组的MA值为(30.85±10.49)mm,AA抑制率(67.50±5.16)%;普通治疗组的MA值为(54.83±8.34)mm,AA抑制率(34.64±6.73)%;两组比较差异均有统计学意义(均P<0.05)。个体化治疗组中有36例患者系血小板功能障碍,予以血小板输注;输入前后的MA值与AA抑制率指标比较,差异均有统计学意义(均P<0.05)。3组患者在3个月时GOS评分分类中恢复好与死亡率比较,个体化治疗组与普通治疗组的差异无统计学意义(P>0.05),但均优于常规化治疗组(均P<0.05)。结论长期口服阿司匹林的脑出血患者,再出血发生率高于未服用阿司匹林脑的出血患者。通过血栓弹力图检测,根据患者的血小板功能与凝血状态进行针对性处理,选择合适的手术方式与时机,可以降低再出血率,改善临床预后。

Objective To investigate the clinical characteristics and individualized treatment strategy of patients with aspirin related intracerebral hemorrhage. Methods The clinical data of 83 patients with aspirin associated intracerebral hemorrhage and 55 without aspirin were analyzed retrospectively. Whether or not the patients with aspirin related intracerebral hemorrhage were examined with a rebound,41 patients in the individualized treatment group were optimized,and 42 patients in the general treatment group. Compared each group in the elasticity,operation mode,rebleeding and GOS score 3 months after the bleeding. Results At the time of admission thrombelastogram detection of platelet function,individual treatment group MA was（ 30. 85 ± 10. 49） mm,AA inhibition rate was（ 67. 50 ± 5. 16） %,normal cerebral hemorrhage group MA was（ 54. 83 ± 8. 34）mm,AA inhibition rate was（ 34. 64 ± 6. 73） %,there was significant difference between two groups（ all P 0. 05）; In the individualized treatment group,there were 36 cases with platelet dysfunction and platelet transfusion. The MA value and AA inhibitory rate index changed significantly before and after the input,and the difference was statistically significant（ all P 0. 05）. In the three groups,the GOS score was better in March than in the group with normal cerebral hemorrhage（ P 0. 05）,but they were better than those in the conventional group（ all P 0. 05）. Conclusion Patients with long-term oral aspirin cerebral hemorrhage and rebleeding rate is higher than that of aspirin in patients with non cerebral hemorrhage,but by thrombela-stogram detection can be carried out targeted treatment,select the appropriate surgical approach and timing based on coagulation and platelet function,can reduce bleeding,improve clinical prognosis.