血栓弹力图对服用抗血小板聚集药物的高血压性脑出血患者治疗及预后的评估价值研究

Evaluation value of thromboelastogram in treatment and prognosis of patients with hypertensive intracerebral hemorrhage taking antiplatelet drugs

目的总结血栓弹力图(TEG)检查在长期服用抗血小板药物的高血压性脑出血患者治疗及预后评估方面的价值。方法回顾性分析2017年1月—2021年12月南京市第一医院及南京脑科医院神经外科收治的因术前长期口服抗血小板药物的高血压性脑出血患者服用的抗血小板药物种类及TEG检查结果,根据花生四烯酸(AA)抑制率高低,分为抑制组及非抑制组。比较抑制组和非抑制组入院的格拉斯哥评分(GCS评分)、影像血肿扩大征(HE征)、血肿扩大或术后再出血、手术例数、手术时间及神经功能恢复情况,并进行统计学分析。结果共纳入具备TEG结果高血压脑出血患者67例,其中服用阿司匹林32例,服用氯吡格雷25例,联合服用阿司匹林和氯吡格雷10例。TEG检查结果显示,AA抑制组39例,未抑制组28例。其中,抑制组HE征13例,未抑制组HE征3例,两组比较有统计学差异(P=0.031);抑制组手术35例,未抑制组手术19例,两组比较有统计学差异(P=0.026)。抑制组术后血肿扩大或术后再出血5例,非抑制组未出现血肿扩大或术后再出血,两组比较有统计学差异(P=0.037)。抑制组手术时长平均(3.3±0.43)h;未抑制组平均(3.9±0.40)h,两组比较有统计学差异(P<0.001)。非抑制组患者入院GCS评分及3个月后随访ADL评分量表均优于抑制组。结论对于服用抗血小板药物的高血压脑出血患者,TEG检查AA抑制率与血肿扩大、手术时间正相关,与患者神经功能障碍恢复结果负相关,可以作为服用抗血小板药物的高血压性脑出血患者预后的独立判断因素。

Objective To summarize the value of thromboelastogram(TEG)parameters in the treatment and prognosis evaluation of hypertensive intracerebral hemorrhage patients with oral antiplatelet drug.Methods The types of antiplatelet drug taken by hypertensive intracerebral hemorrhage patients admitted to Nanjing First Hospital and Nanjing Brain Hospital from January 2017 to December 2021 due to long-term oral antiplatelet before surgery and the results of TEG were analyzed retrospectively.According to the inhibitory rate of arachidonic acid(AA),patients were divided into inhibitory group and non-inhibitory group.The imaging HE signs,hematoma enlargement or postoperative rebleeding,number of surgical cases,operation time and neurological function recovery were compared between the inhibition group and the non-inhibition group,and statistical analysis was performed.Results A total of 67 patients with hypertensive intracerebral hemorrhage with TEG results were included,including 32 patients taking aspirin,25 taking clopidogrel,and 10 taking combined aspirin and clopidogrel.According to the results of TEG,39 cases belong to the AA inhibition group and 28 belong to the non-inhibition group.There were 13 cases of HE sign in inhibition group and 3 of HE sign in non-inhibition group.There was statistical difference between the two groups(P=0.031).In the inhibition group,35 patients underwent surgery.While in the non-inhibition group,19 patients underwent surgery.There was statistical difference between the two groups(P=0.026).There were 5 cases of hematoma enlargement or postoperative rebleeding in the inhibition group,and no hematoma enlargement or postoperative rebleeding in the non-inhibition group,with statistical difference between the two groups(P=0.037).The average operation time of the inhibition group was(3.3±0.43)hours.The average duration of surgery in the uninhibited group was(3.9±0.40)hours.The GCS score at admission and following ADL score scale after 3 months in the non-inhibited group were better than those in the inhibited group.Conclusion For hypertensive intracerebral hemorrhage patients taking antiplatelet drugs,thrombolysis diagram shows a positive correlation between AA inhibition rate and hematoma enlargement and operation time,and a negatively correlated with the outcome of neurological dysfunction recovery,which can be used as an independent prognostic factor for patients with hypertensive intracerebral hemorrhage taking antiplatelet drugs.