动脉瘤性蛛网膜下腔出血首日凝血功能研究

Study on coagulation function of aneurysmal subarachnoid hemorrhage on the first day

目的动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)后凝血功能异常影响患者预后。探讨aSAH首日患者凝血功能变化,并分析其与反映意识障碍程度的相关性。为重症aSAH患者首日精细化管理提供参考。方法40例发病24 h内入住神经重症监护室的aSAH患者,与20例年龄、性别相匹配的健康对照组进行比较。对血栓弹力图(thrombelastography,TEG)结果、GCS评分进行分析;根据入院时GCS评分进行亚组分析,比较GCS≤7和GCS>7亚组TEG各项结果;并分析其与GCS的相关性。结果与对照组比较,aSAH患者首日反应凝血因子功能的TEG-R值明显降低(4.18±1.54 vs 6.61±0.95,P=0.001);纤溶系统(LY30、EPL)和其他指标(MA、K、Angel)、常规凝血功能差异无统计学意义(P>0.05)。GCS≤7亚组较GCS>7亚组TEG-R值也明显降低(3.32±1.04 vs 5.24±1.41,P<0.001),且TEG-R与GCS评分具有相关性(r=0.551,P<0.001)。结论aSAH首日患者凝血因子功能增强的高凝状态,尤其是GCS≤7的患者,且与GCS高度相关;但纤溶系统无明显变化。

Objective To investigate the influence of coagulation dysfunction on the prognosis of patients with severe aneurysmal subarachnoid hemorrhage(aSAH).To explore the changes of coagulation function in patients with aneurysmal subarachnoid hemorrhage(aSAH) on the first day,and to analyze the correlation between the changes and the degree of reflecting the disturbance of consciousness.To provide reference for the first day fine management of severe aSAH patients.Methods 40 patients with aSAH who were admitted to NICU within 24 hours after onset were compared with 20 age and gender matched healthy controls.The results of thromboelastography(TEG),GCS score were compared;the results of TEG in subgroups with GCS ≤ 7 and GCS>7 were compared according to GCS score at admission;and the correlation with GCs was analyzed.Results Compared with the control group,the first day’s TEG-R of the patients with aSAH was significantly lower(4.18±1.54 vs 6.61±0.95,P=0.001);there was no significant difference in the fibrinolytic system(ly30,EPL) and other indicators(MA,K,angel).The value of TEG-R in GCS ≤ 7 subgroup was significantly lower than that in GCS>7 subgroup(3.32±1.04 vs 5.24±1.41,P<0.001),and TEG-R was closely related to GCS score(r=0.551,P<0.001).Conclusion The hypercoagulable state of enhanced coagulation factor function in aSAH patients on the first day,especially those with GCS ≤ 7,is highly correlated with GCS.That is to say,the more serious the disease is,the more obvious the hypercoagulability is,but the fibrinolysis system has no obvious change.