血栓弹力图MA和CI参数与颅脑创伤患者迟发性颅内血肿的关系

Association of Maximal Amplitude of Thromboelastography and CI with Delayed Intracranial Hematoma in Patients with Craniocerebral Trauma

目的分析血栓弹力图(thromboelastography,TEG)最大振幅(maximal amplitude,MA)、凝血指数(clotindex,CI)与颅脑创伤患者迟发性颅内血肿(Delayed traumatic intracranial hematoma,DTICH)的关系。方法将医院2014年1月~2 0 1 8年2月收治1 5 0例颅脑创伤患者按是否发生迟发性颅内血肿设DTICH组(n=36)、非DTICH组(n=114),采集两组一般临床资料及TEGMA、CI参数,分析其与颅脑创伤患者DTICH的关系。结果DTICH组中瞳孔改变、Babinski征、颅骨骨折、脑疝、基底池受压比例及舒张压水平均明显高于非DTICH组(P<0.05);且DTICH组创伤后第5天、第10天、第1 5天时MA>7 0 mm、CI≥3比例及△MA5-1、△MA10-1、△MA1 5-1、△CI5-1、△CI5-1、△CI1 5-1均显著高于非DTICH组(P<0.05);多因素Logistic回归分析显示入院时合并Babinski征、颅骨骨折、△MA5-1均为颅脑损伤患者迟发性血肿的危险因素,手术时机为保护因素;△MA5-1预测DTICH的ROC曲线下面积为0.640,最佳敏感阀值为3.047,敏感度为71.40%、特异度为60.41%;以△MA5-1>3.047为分组条件,△MA5-1>3.047组15 d累积生存率显著低于△MA5-1≤3.047组,差异有统计学意义(χ^2=5.143,P=0.023)。结论△MA5-1与入院时合并Babinski征、颅骨骨折均为颅脑损伤患者迟发性血肿的危险因素,临床应加强此类患者凝血监测,当△MA5-1>3.047时,不仅提示高迟发性血肿风险,亦提示预后不良。

Objective To analyze the association of the maximal amplitude(MA) of thromboelastography(TEG) and clot index(CI) with delayed traumatic intracranial hematoma(DTICH) in patients with craniocerebral trauma.Methods One hundred and fifty patients with craniocerebral trauma in the hospital were collected between 2014 to 2018.The Patients were divided into DTICH group(n=36) and non-DTICH group(n=114) by presence or absence of delayed traumatic intracranial hematoma.General clinical data,MA of TEG and CI in the two groups were collected and analyzed for their relations with DTICH.Results The rates of pupillary changes,Babinski sign,skull fracture,cerebral palsy,basal cistern compression and the level of diastolic blood pressure in the DTICH group were significantly higher than those in the non-DTICH group(both P<0.05).The rates of MA greater than 70 mm,CI greater than or equal to 3 and △MA5-1,△MA10-1,△MA15-1,△CI15-1,△CI10-1,△CI15-1 on days 5,10 and 15 after trauma in the DTICH group were remarkably elevated compared to those in the non-DTICH group(P<0.05).Multivariate logistic regression analysis showed that combined Babinski sign,skull fracture and △MA5-1 at admission were risk factors for DTICH in patients with craniocerebral trauma while the timing of surgery was a protective factor.The area under the ROC curve with △MA5-1 predicting DTICH was 0.640,the optimal sensitivity threshold was 3.047,with the sensitivity of 71.40% and the specificity of 60.41%.Taking△MA5-1 over 3.047 as the grouping cut-off value,we found a lower cumulative survival rate on day 15 than that of △MA5-1 below 3.047 group(χ2=5.143,P=0.023).Conclusions The △MA5-1,combined Babinski sign at admission and skull fracture are risk factors for DTICH in patients with craniocerebral trauma.Clinical coagulation monitoring is needed.The △MA5-1 more than 3.047 would indicate a high risk of DTICH and poor prognosis.