药物抑制率联合K值、年龄与GCS评分对钝性重型颅脑损伤预后的评估价值

Evaluation value of drug inhibition rate combined with K value,age and GCS score in prognosis of blunt severe traumatic brain injury

目的探讨药物[血小板花生四烯酸(AA)、血小板二磷酸腺苷(ADP)]抑制率联合血凝块形成时间(K值)、年龄与格拉斯哥昏迷量表(GCS)评分对钝性重型颅脑损伤(TBI)患者预后的评估价值。方法选择2021年1月至2022年12月该院收治的未使用抗血小板药物治疗的急诊钝性重型TBI患者184例,根据患者28 d病情好转情况分为预后良好组、预后不良组,比较两组患者一般资料。采集两组患者静脉血,均行TEG检查并比较两组患者凝血反应时间(R值)、血凝块形式时间(K值)、血凝块形成的最大幅度(MA值)、血凝块形成速率(α角)、血凝块力学强度(G值)、AA抑制率、ADP抑制率。采用多因素Logistic回归分析影响钝性重型TBI患者预后的因素。采用受试者工作特征(ROC)曲线分析药物抑制率联合K值、年龄、GCS评分对钝性重型TBI患者预后的评估价值。结果预后良好组138例,预后不良组46例。预后不良组患者年龄≥45岁、头部AIS评分5~6分、入院后插管比例、K值、AA抑制率、ADP抑制率明显高于预后良好组,R值、α角、MA值、G值、GCS评分明显低于预后良好组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥45岁,K值、AA抑制率、ADP抑制率升高为钝性重型TBI患者预后不良的危险因素(P<0.05),GCS评分升高为钝性重型TBI患者预后不良的保护因素(P<0.05)。ROC曲线分析发现,AA抑制率、ADP抑制率、年龄、K值及GCS评分联合检测对钝性重型TBI预后的评估价值较高。结论AA抑制率和ADP抑制率升高、GCS评分降低、K值升高可作为预警指标,辅助评估钝性重型TBI患者的预后情况。

Objective To investigate the evaluation value of the drug[platelet arachidonic acid(AA),platelet adenosine diphosphate(ADP)]inhibiting rate combined with blood clot formation time(K value),age and GCS score on the prognosis of the patients with blunt severe traumatic brain injury(TBI).Methods A total of 184 patients with acute blunt severe TBI without using antiplatelet drugs admitted and treated in this hospital from January 2021 to December 2022 were selected.The patients were divided into good prognosis group and poor prognosis group according to their condition improvement on 28 d.The general data of the two groups were compared.The venous blood was collected in both groups.The TEG examination was conducted in the two groups and the coagulation reaction time(R),K value,maximum amplitude of clot formation(MA value),formation rate(α angle),blood clot mechanical strength(G value),AA inhibition rate and ADP inhibition rate were compared between the two groups,and the multivariate Logistic regression analysis was used to analyze the risk factors affecting the poor prognosis of the patients with blunt severe TBI.The receiver operating characteristic(ROC)curve was used to analyze the evaluation value of drug inhibiting rate combined with K value,age and GCS score in the prognosis in the patients with blunt severe TBI.Results There were 138 cases in the good prognosis group and 46 cases in the poor prognosis group.The patients with age≥45 years old,head AIS score(5—6 points),intubation ratio after admission,K value,AA inhibition rate and ADP inhibition rate in the poor prognosis group were significantly higher than those in the good prognosis group,and R value,α angle,MA value,G value and GCS score were significantly lower than those in the good prognosis group,with statistically significant difference(P<0.05).Multivariate Logistic regression analysis showed that age≥45 years old,the increase of K value,AA inhibiting rate and ADP inhibiting rate were the risk factors affecting poor prognosis in the patients with blunt severe TBI.The increase of GCS score was a protective factor for the good prognosis of patients with blunt sever TBI(P<0.05).The ROC curve analysis found that the AA inhibiting rate,ADP inhibiting rate,age,K value and GCS score combined detection had the high evaluation value for the prognosis in blunt severe TBI.Conclusion The increase of AA inhibiting rate and ADP inhibiting rate,GCS score decrease and K value increase could serve as the early warning indicators to assist in assessing the prognosis of the patients with blunt severe TBI.