破血逐瘀药物治疗超急性脑出血中凝血指标的价值分析

Analysis of the value of blood coagulation indexes in the treatment for hyperacute intracranial hemorrhage with the drugs for breaking the blood to move stasis

目的研究破血逐瘀药物治疗脑出血超急性期患者凝血指标的变化及对预后的评估价值。方法选取符合标准的发病6 h以内住院脑出血患者63例,随机双盲分为药物组31例和安慰剂组32例,另选择同期健康查体老年健康人31例作为健康组。所有脑出血患者均给予脱水降颅压、控制高血压、防治并发症等常规对症治疗,药物组患者同时给予破血逐瘀中药颗粒剂口服或鼻饲,安慰剂组患者同时给予安慰剂口服或鼻饲,均连续10 d。检测药物组和安慰剂组入院时、入院24 h、入院72 h凝血指标[凝血酶原时间(PT)、部分活化凝血酶时间(APTT)、纤维蛋白原(FIB)、国际标准化比值(INR)、D-二聚体(DD)],并与健康组比较; CT检测药物组和安慰剂组入院时、入院72 h、入院10～14 d血肿体积,比较药物组和安慰剂组入院时和治疗后3个月NHISS评分,统计治疗后3个月患者改良Rankin量表预后分级情况,并分析预后与凝血指标的关系。结果药物组和安慰剂组各时间点INR与健康组比较差异均无统计学意义(P均> 0. 05),入院24 h和72 h的PT、APTT、FIB、D-D水平均明显高于健康组(P均<0. 05),但2组间比较差异均无统计学意义(P均> 0. 05);药物组和安慰剂组各时间点血肿体积及治疗后3个月NHISS评分、预后良好率比较差异均无统计学意义(P均> 0. 05),但预后良好组FIB和D-D水平明显低于预后不良组(P均<0. 05)。结论脑出血超急性期服用破血逐瘀药物可能是安全的,早期检测各凝血功能指标可能有助于判断短期预后。

Objective It is to study the changes of coagulation parameters and its evaluation of prognosis in patients with hyperacute cerebral hemorrhage treated with the drugs for breaking the blood to move stasis.Methods Sixty-three patients with cerebral hemorrhage hospitalized within 6 hours after the onset and met the standard were selected and divided into the drug group(n=31)and the placebo group(n=32)by a random and double blind method.Another 31 elder healthy people were selected as healthy group.All patients with cerebral hemorrhage were given conventional symptomatic treatments such as dehydration and intracranial pressure reduction,hypertension control,and prevention and treatment of complications.The patients in the drug group were given oral or nasal feeding with granules for breaking the blood to move stasis,and the patients in the placebo group were given oral or nasal feeding with placebo,all the patients were treated for 10 days.Coagulation parameters[prothrombin time(PT),partial activated thrombin time(APTT),fibrinogen(FIB),international normalized ratio(INR),D-Dimer(D-D)]at the time of admission,24 and 72 hours after admission in the drug group and placebo group were determined and compared with the healthy group.Hematoma volume was detected by CT at admission,72 hours after admission,10-14 days after admission in the drug group and placebo group.The NHISS scores at admission and after treatment for 3 months were compared between the drug group and placebo group.The prognosis grading assessed by the modified Rankin scale was calculated after treatment for 3 months,and the relationship between prognosis and coagulation parameters was analyzed.Results There was no significant difference in INR between the drug group and the placebo group at each time point(P>0.05).The levels of PT,APTT,FIB,and D-D at 24h and 72h after admission in the drug group and the placebo group were significantly higher than those in the healthy group(P<0.05),but there was no significant difference between the two groups(P>0.05).There was no statistical difference in the volume of hematoma and the difference of NHISS score and good prognosis between the drug group and the placebo group at each time point(P>0.05),but the levels of FIB and D-D were significantly lower in good prognosis group than those in the poor prognosis group(P<0.05).Conclusion It may be safe to take the drugs for breaking the blood to move stasis in the hyperacute phase of cerebral hemorrhage.Early detection of various coagulation function indicators may help to judge short-term prognosis.