血栓弹力图与常规凝血相关指标预测颅脑损伤术后产生深静脉血栓的价值

Value of thromboelastography and conventional coagulation-related indexes in predicting deep vein thrombosis after traumatic brain injury

目的:探讨血栓弹力图(TEG)与常规凝血指标预测颅脑损伤术后下肢深静脉血栓(DVT)的价值。方法:选取241例行手术治疗的颅脑损伤患者为研究对象,根据术后1个月内是否发生DVT分为DVT组(n=40)和无DVT组(n=201)。比较术前两组患者常规凝血相关指标[血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、D-二聚体(D-D)、凝血酶时间(TT)]及TEG参数[凝血反应时间(R)、血液凝固时间(K)、凝固角(α)、最大振幅(MA)],分析上述指标对颅脑损伤术后DVT的预测价值。结果:241例患者有40例术后发生DVT,发生率为16.60%,其中17例(42.50%)单独左下肢,16例(40.00%)单独右下肢,7例(17.50%)为双下肢DVT。DVT组患者术前PT、APTT、TT、R、K低于无DVT组(P<0.05);Fib、D-D、α角、MA高于无DVT组(P<0.05)。常规凝血指标中,PT与R呈正相关,与α角呈负相关(P<0.05);APTT与R、K均呈正相关,与α角呈负相关(P<0.05);Fib与R呈负相关,与α角呈正相关(P<0.05);D-D与TEG各指标无相关性(P>0.05);TT与R、K及MA呈正相关,与α角呈负相关(P<0.05)。MA、APTT、Fib、D-D均对DVT发生有良好的预测价值,AUC分别为0.856、0.826、0.815和0.804;K、TT及α角对DVT的发生具有中等预测价值,AUC分别为0.776、0.745、0.737;R对DVT发生的预测价值较低,AUC为0.675。结论:颅脑损伤术后DVT的发生率较高,可将APTT、Fib、D-D及TT等常规凝血指标与MA、K和α角等TEG相关指标作为临床筛查DVT的辅助指标。

Objective:To investigate the value of thromboelastography(TEG)and conventional coagulation-related indexes in predicting lower extremity deep vein thrombosis(DVT)after traumatic brain injury.Methods:241 patients with craniocerebral injury underwent surgical treatment were selected as the research objects,and divided into DVT group(n=40)and non DVT group(n=201)according to whether DVT occurred within 1 month after operation.The routine coagulation related indexes[plasma prothrombin time(PT),activated partial clotting enzyme live time(APTT),fibrinogen(Fib),D-dimer(D-D),thrombin time(TT)]and TEG parameters[coagulation reaction time(R),blood coagulation time(K),Angle of solidification(alpha),the maximum amplitude(MA)]were compared between the two groups before operation,and the predictive value of the above indicators for DVT after craniocerebral injury were analyzed.Results:A total of 40 patients developed DVT after examination,and the incidence rate was 16.60%.Among them,17 analyzed patients(42.50%)had the left lower extremity alone,16 patients(40.00%)had the right lower extremity alone,and 7 patients(17.50%)was DVT of both lower extremities.Before operation,the PT,APTT,TT,R,and K of the patients in the DVT group were lower than those in the non-DVT group(P<0.05),and their Fib,D-D,αangle and MA were higher than those in the non-DVT group(P<0.05).Among routine coagulation indexes,PT was positively correlated with R and negatively correlated withαangle(P<0.05),APTT was positively correlated with R and K,and negatively correlated withαangle(P<0.05),Fib was negatively correlated with R,there was a positive correlation withαangle(P<0.05),DD had no correlation with TEG indicators(P>0.05),TT was positively correlated with R,K and MA,and negatively correlated withαangle(P<0.05).MA,APTT,Fib,and DD all had good predictive value for the occurrence of DVT,and AUC were 0.856,0.826,0.815,and 0.804,respectively.K,TT,andαangles had moderate predictive value for the occurrence of DVT,and AUC were 0.776,0.745,0.737,respectively.R had a lower predictive value for the occurrence of DVT,and the AUC was 0.675.Conclusion:The incidence of DVT after craniocerebral injury is high,and conventional coagulation indexes such as APTT,Fib,D-D and TT and TEG-related indexes such as MA,K andαangle can be used as auxiliary indexes for clinical screening of DVT.