自发性脑出血患者凝血功能与脑血肿及脑水肿的关系

Relationship of coagulation function with cerebral hematoma and edema in spontaneous intracerebral hemorrhage patients

目的探讨自发性脑出血患者出血后体内凝血变化及与脑血肿和脑水肿的关系。方法选择2013年2月~2014年5月保定市满城区人民医院神经内科住院的自发性脑出血患者20例。分别于入院时以及入院第4、8和15天(或出院时)抽取患者静脉血,采用自动校正凝血酶曲线法检测患者凝血功能,其主要参数包括:延迟时间、凝血酶生成潜力、峰值和达峰时间;并行头颅CT平扫检查,应用多田公式计算脑血肿和脑水肿体积,分析其与凝血功能的相关性。结果脑出血患者入院时、入院第4、8、15天凝血酶生成潜力、峰值、达峰时间、脑血肿体积和脑水肿体积比较,差异有统计学意义(P<0.01)。Pearson相关性分析显示,延迟时间和达峰时间与脑血肿体积、脑水肿体积呈正相关(r=0.498,P=0.025;r=0.517,P=0.020;r=0.492,P=0.028;r=0.472,P=0.036),凝血酶生成潜力和峰值与脑血肿体积、脑水肿体积呈负相关(r=-0.560,P=0.010;r=-0.480,P=0.032;r=-0.485,P=0.030;r=-0.469,P=0.037)。结论脑出血患者体内凝血功能呈现出动态改变,凝血功能变化与脑血肿体积及脑水肿体积变化相关,凝血功能检测可能是脑出血患者病情预后的重要指标之一。

Objective To study the relationship of coagulation function with cerebral hematoma and edema in spontaneous ICH patients.Methods Twenty spontaneous ICH patients were included in this study.Their venous blood samples were taken at admission and on days 4,8,15 after admission.Their coagulation function parameters, such as delayed time, thrombin generation potential, peak value, time to peak value, were detected by automatically adjusted thrombin curve analysis.The hematoma and edema size were measured by head CT scanning according to Duotian formula.Results Significant difference was detected in thrombin generation potential, peak value, time to peak value, hematoma and edema size at different time points(P<0.01).Pearson correlation analysis showed that the delayed time and time to peak value were positively related with the hematoma and edema size(r=0.498,P=0.025;r=0.517,P=0.020;r=0.492,P=0.028;r=0.472,P=0.036) while the thrombin generation potential and peak value were negatively related with the hematoma and edema size(r=-0.560,P=0.010;r=-0.480,P=0.032;r=-0.485,P=0.030;r=-0.469,P=0.037).Conclusion The coagulation function in ICH patients is characterized by dynamic change.The change of coagulation function is related with that of hematoma and edema size.The detection rate of coagulation function is one of the important indicators of the outcome in ICH patients.