血栓弹力图参数与脑出血患者脑血肿体积及预后的关系

The association between thromboelastogram parameters and cerebral hematoma volume,clinical prognosis of cerebral hemorrhage patients

目的研究血栓弹力图参数与脑出血患者脑血肿体积及预后的关系。方法回顾性分析2017年4月至2020年10月西安市第三医院收治的150例脑出血患者的临床资料,根据入院时的格拉斯哥昏迷评分(Glasgow coma score,GCS)将研究对象分为轻度组(GCS≥13分,50例)、中度组(9分≤GCS≤12分,62例)和重度组(GCS≤8分,38例)。另取同期来院进行健康体检的志愿者60例作为对照组。比较分析四组的血栓弹力图参数以及其与脑血肿体积的相关性。采用多因素logistic回归方法分析影响脑出血患者预后不良的独立危险因素。结果轻度组、中度组、重度组患者的凝血反应时间、凝血形成时间均显著长于对照组(P<0.05),中度组、重度组显著长于轻度组(P<0.05),重度组显著长于中度组(P<0.05);轻度组、中度组、重度组患者的血栓最大振幅、凝固角均显著小于对照组(P<0.05),中度组、重度组显著小于轻度组(P<0.05),重度组显著小于中度组(P<0.05)。Pearson相关性分析结果显示,凝血反应时间、凝血形成时间与脑血肿体积呈正相关(r=0.251,P<0.05;r=0.194,P<0.05),血栓最大振幅、凝固角与脑血肿体积呈负相关(r=-0.221,P<0.05;r=-0.183,P<0.05)。多因素logistic回归分析结果显示,凝血反应时间、凝血形成时间、血栓最大振幅、凝固角、凝血酶原时间、活化部分凝血活酶时间和D-二聚体是脑出血患者预后不良的独立影响因素(P<0.05)。结论血栓弹力图参数中的凝血反应时间、凝血形成时间与脑血肿体积呈正相关,血栓最大振幅、凝固角与脑血肿体积呈负相关。且血栓弹力图参数和凝血功能指标是脑出血患者预后不良的独立影响因素。

Objective To study the association between thromboelastogram parameters and cerebral hematoma volume,clinical prognosis of cerebral hemorrhage patients.Method Clinical data of 150 patients with cerebral hemorrhage admitted to Xi’an Third Hospital from April 2017 to October 2020 were retrospectively analyzed.According to Glasgow coma score(GCS)at admission,the subjects were divided into mild group(GCS≥13,50 cases)and moderate group(9≤GCS≤12,62 cases)and severe group(GCS≤8,38 cases).Another 60 healthy volunteers were selected as the control group.The thromboelastogram parameters of the four groups and their correlation with cerebral hematoma volume were compared and analyzed.Multivariate logistic regression was used to analyze the independent factors influencing poor prognosis of patients with cerebral hemorrhage.Result The coagulation reaction time and coagulation formation time of patients in mild,moderate and severe groups were significantly longer than those in control group(P<0.05),the moderate and severe groups were significantly longer than those in mild group(P<0.05),and the severe group was significantly longer than those in moderate group(P<0.05).The maximum amplitude and coagulation angle of thrombus in mild,moderate and severe groups were significantly lower than those in control group(P<0.05),the moderate and severe groups were significantly lower than those in mild group(P<0.05),and the severe group was significantly lower than those in moderate group(P<0.05).Pearson correlation analysis showed that coagulation reaction time and coagulation formation time were positively correlated with cerebral hematoma volume(r=0.251,P<0.05;r=0.194,P<0.05),the maximum amplitude and coagulation angle of thrombus were negatively correlated with cerebral hematoma volume(r=-0.221,P<0.05;r=-0.183,P<0.05).Multivariate logistic regression analysis showed that coagulation reaction time,coagulation formation time,maximum amplitude of thrombi,coagulation angle,PT,APTT and D-D were independent factors for poor prognosis of patients with cerebral hemorrhage(P<0.05).Conclusion The coagulation reaction time and coagulation formation time in thromboelastic diagram were positively correlated with the volume of cerebral hematoma,while the maximum amplitude and coagulation angle of thrombus were negatively correlated with the volume of cerebral hematoma.The parameters of thrombolysis and coagulation function were independent factors of poor prognosis in patients with intracerebral hemorrhage.