血栓弹力图与常规凝血功能监测在早期脑出血患者再出血中的临床意义

Clinical significance of thromboelastography and routine coagulation function monitoring in rebleeding of patients with early intracerebral hemorrhage

目的探讨血栓弹力图与常规凝血功能监测在早期脑出血患者再出血中的临床意义。方法选取2019年1月至2021年5月内蒙古自治区人民医院收治的109例早期脑出血患者的临床资料,根据是否发生再出血将入选患者分为再出血组(42例)与未再出血组(67例)。两组患者入院后立即进行常规凝血功能及血栓弹力图检测。比较两组患者的常规凝血功能及血栓弹力图指标,分析常规凝血功能及血栓弹力图指标对早期脑出血患者再出血的影响,组间比较采用独立样本t检验;相关影响因素分析采用Logistic回归分析。结果再出血组的凝血酶原时间(PT)、凝血酶时间(TT)、凝血反应时间(R)长于未出血组,最大切应力系数(MA值)短于未出血组,差异有统计学意义(再出血组:14.62±2.73、23.17±4.28、11.06±1.41、46.82±5.16;未出血组:10.95±1.62、18.36±3.81、6.73±0.95、61.25±6.32;t=4.038、6.206、5.839、13.053,P<0.05)。两组的活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、血凝块形成时间(K)、α角比较,差异无统计学意义(再出血组:31.07±6.83、2.37±0.45、1.78±0.24、58.13±6.81;未出血组:30.85±5.24、2.19±0.38、1.81±0.17、57.94±7.37,t=1.649、1.317、0.735、1.724,P>0.05)。Logistic回归分析结果显示,PT、TT、R时间、MA值为早期脑出血患者再出血的影响因素。结论血栓弹力图与常规凝血功能监测在早期脑出血患者再出血中具有一定的临床意义,PT、TT、R时间、MA值为早期脑出血患者再出血的影响因素。

Objective To explore the clinical significance of thromboelastography and routine coagulation function monitoring in rebleeding of patients with early intracerebral hemorrhage.Methods The clinical data of 109 patients with early intracerebral hemorrhage treated in our hospital from January 2019 to May 2021 were selected.According to whether rebleeding occurred,the selected patients were divided into the rebleeding group(42 cases)and the non rebleeding group(67 cases).Routine coagulation function and thromboelastogram were detected immediately after admission.The routine coagulation function and thromboelastogram indexes of the two groups were compared,and the influence of routine coagulation function and thromboelastogram indexes on rebleeding in patients with early intracerebral hemorrhage were analyzed.Results Prothrombin time(PT),thrombin time(TT)and coagulation reaction time(R)in the rebleeding group were longer than those in the non bleeding group,and the maximum shear stress coefficient(MA value)in the non bleeding group was shorter than that in the non bleeding group,the differences were statistically significant(the rebleeding group:14.62±2.73,23.17±4.28,11.06±1.41,46.82±5.16;the non bleeding group:10.95±1.62,18.36±3.81,6.73±0.95,61.25±6.32,t=4.038,6.206,5.839,13.053,P<0.05).There were no significant difference in the indexes of activated partial thromboplastin time(APTT),fibrinogen(FIB),blood clot formation time(K)andαAngle between the two groups(the rebleeding group:31.07±6.83,2.37±0.45,1.78±0.24,58.13±6.81;the non bleeding group:30.85±5.24,2.19±0.38,1.81±0.17,57.94±7.37,t=1.649,1.317,0.735,1.724,P>0.05).Logistic regression analysis showed that PI,TT,R time and MA were the influencing factors of rebleeding in patients with early intracerebral hemorrhage.Conclusion Thromboelastogram and routine coagulation function monitoring have certain clinical significance in rebleeding in patients with early intracerebral hemorrhage.PT,TT,R time and MA are the influencing factors of rebleeding in patients with early intracerebral hemorrhage.