颅脑损伤患者入院凝血指标与患者伤情的相关性分析

Correlation Analysis of Blood Coagulation Index and Severity in Patients with Craniocerebral Injury

目的:探讨颅脑损伤患者入院时凝血指标与病情严重程度的相关关系。方法:收集2017年10月至2018年10月入住于我院神经外科的87例颅脑损伤患者的病历资料,用入院时格拉斯哥评分(Glasgow Coma Scale,GCS)评价患者伤情严重程度,应用双变量回归分析、建立多元线性回归方程、绘制受试者工作特征曲线(area under the receiver-operating characteristic curve,ROC)等方法,分析患者入院时凝血指标与病情严重程度的相关性。结果:经双变量相关分析,入院时GCS与血凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-Dimer,D-D)、白蛋白(albumin,ALB)及血糖(glucose,GLU)值均有相关性,差异均有统计学意义(P<0.05)。经逐步拟合,有三个自变量选入最优多元回归分析方程,即为D-D、PT和GLU,R=0.836,R2=0.615。绘制ROC曲线分析结果示:D-D、PT和GLU预测颅脑损伤患者入院GCS值的ROC曲线下面积分别为0.863、0.736和0.727,说明当患者入院时的血D-D值≥4.58ug/ml、血PT值≥13.55s血GLU值≥8.29mmol/L时,提示患者伤情较重。结论:在颅脑损伤患者早期的病情判断中,凝血指标的变化对患者的伤情具有预测意义,可结合患者伤后血D-D、PT、GLU值协助判断患者病情,及时给予相应处理。

Objective:To explore the correlation between coagulation index and severity of patients withcraniocerebral injury.Methods:To collectmedical records of 87 patients with craniocerebral injuryfromOctober 2017 to October 2018,useglasgow coma scale to assess the severity of injury,make use ofbivariate regression analysis,multiple linear regression equation andarea under the receiver-operating characteristic curve(ROC)to analyze the correlation between coagulation index and severity.Results:Bivariate regression analysis results showed that GCS was correlated with prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),d-dimer(D-D),albumin(ALB)and glucose(GLU),there were significant difference(P<0.05).By using stepwise fitting,three independent variables were selected intooptimal multiple regression analysis equation,they were D-D,PT and GLU,R=0.836,R2=0.615.The ROC curve analysis results showed that the area under the ROC curve of D-D,PT and GLU predicted the GCS value of patients with craniocerebral injury were respectively 0.863,0.736 and 0.727,indicating that when blood D-D value ≥4.58ug/ml,blood PT value ≥13.55s and blood GLU value ≥8.29mmol/L,the patients was in critical condition.Conclusion:In the early judgment of patients with craniocerebral injury,the change of coagulation index has predictive significance for the patient's injury,which could be combined with the patient's post-injury blood D-D,PT,GLU value to help determine the patient's condition,andthentimely gave corresponding treatment.