急性缺血性脑卒中输血治疗患者凝血功能血栓弹力图检测及其临床意义

Coagulation Function and Thromboelastography Detection in Patients with Acute Ischemic Stroke Treated with Blood Transfusion and Its Clinical Significance

目的:研究急性缺血性脑卒中输血治疗患者凝血功能、血栓弹力图(TEG)检测及其临床意义。方法:选取本院2017年1月至2019年6月收治的120例行血管内治疗的急性缺血性脑卒中患者作为研究对象,同期选取在本院接受健康体检的34例体检者作为对照组。比较不同组别TEG、常规凝血试验指标,TEG参数包括R时间、K时间、α角度、最大幅度(MA);分析缺血性脑卒中患者TEG、常规凝血试验参数相关性;分析不同方法对脑出血、早期神经功能恶化等并发症的诊断敏感性、特异性及准确性。结果:与对照组比较,缺血性脑卒中组患者TEG试验指标R时间和K时间明显缩短,而α角度与MA值明显较对照组增大(P<0.05);常规凝血试验指标APTT较对照组明显缩短,FIB浓度增高(P<0.05),表明存在血液高凝状态。并发症组TEG试验指标R时间和K时间较无并发症明显缩短,而α角度与MA值明显较无并发症组增大(P<0.05);常规凝血试验指标APTT较无并发症组明显缩短,FIB浓度增高(P<0.05)。R时间与PI、ATPP呈明显正相关(P<0.05),与FBI无明显相关性(P>0.05);K时间与FBI呈负相关,α角度、MA与FIB呈正相关(P<0.05),上述TEG试验参数与PI、ATPP均无明显相关性(P>0.05)。TEG判断症状性脑出血的敏感性、特异性及准确性分别为76.92%、89.72%、88.33%,判断早期神经功能恶化分别为16.67%、92.59%、85.00%;常规凝血试验判断症状性脑出血的敏感性、特异性及准确性分别为46.15%、72.90%、70.00%,判断早期神经功能恶化分别为58.33%、66.67%、65.83%。结论:TEG检测参数可有效反映急性缺血性脑卒中患者体内的凝血变化过程,且与常规凝血试验指标间水平存在一定的相关性,临床可根据患者实际情况选择合适的检测方法。

Objective:To study the coagulation function and thromboelastography(TEG)detection in patients with acute ischemic stroke treated with blood transfusion and its clinical significance.Methods:120 patients with acute ischemic stroke who were treated with endovascular therapy in our hospital from January 2017 to June 2019 were selected as the research object,and 34 health controls were selected as the control group.The indexes of TEG and conventional coagulation test,and TEG parameters including R time,K time,αangle,and maximum amplitude(MA)between the two groups were compared.Correlation between TEG and parameters of onventional coagulation test in patients with ischemic stroke was analyzed.The sensitivity,specificity,and accuracy of different methods in the diagnosis of complications such as cerebral hemorrhage and early neurological deterioration were calculated.Results:Compared with those in the control group,the T and R times of the TEG test indicators in the ischemic stroke group were significantly shorter,while theαangle and the MA value were significantly larger(P<0.05).The conventional coagulation test index APTT was significantly shorter than that of the control group,and the FIB concentration increased(P<0.05),indicating the hypercoagulable state.The T time and K time of the TEG test indexes in the complication group were significantly shorter than those in the non-complication group,while theαangle and MA value were significantly increased compared with those in the non-complication group(P<0.05).The index of routine coagulation test APTT was significantly shorter than that of the non-complication group,and the FIB concentration increased(P<0.05).R time was significantly positively correlated with PI and ATPP(P<0.05),but there was no significant correlation between R time and FBI(P>0.05).K time was negatively correlated with FBI,andαangle and MA were positively correlated with FIB(P<0.05).The above parameters of TEG test had no significant correlation with PI and ATPP(P>0.05).The sensitivity,specificity,and accuracy of TEG in the diagnosis of symptomatic cerebral hemorrhage were 77.78%,89.19%,and 88.33%,respectively,and in the diagnosis of early neurological deterioration,16.67%,92.59%and 85.00%,respectively.The sensitivity,specificity,and accuracy of conventional coagulation tests in the diagnosis of symptomatic cerebral hemorrhage were 46.15%,72.90%,and 70.00%,respectively,and in the diagnosis of early neurological deterioration,58.33%、66.67%、65.83%,respectively.Conclusion:The parameters of TEG detection can effectively reflect the process of coagulation changes in patients with acute ischemic stroke,and have some correlation with the indicator levels of conventional coagulation test.In clinical practice,the appropriate detection method can be selected according to the actual situation of the patient.