高血压脑出血患者急诊开颅术前凝血功能与预后的相关性研究

Correlation between preoperative coagulation function and prognosis in patients with hypertensive cerebral hemorrhage undergoing emergency craniotomy

目的探讨高血压脑出血患者急诊开颅术前凝血功能与预后的关系。方法回顾性选取82例急诊行开颅手术治疗的高血压脑出血患者(观察组)和50名健康志愿者(对照组)作为研究对象。观察组患者根据入院时格拉斯哥昏迷评分法(GCS)评分又分为轻中度组31例和重度组51例,根据格拉斯哥预后评分(GOS)又分为预后不良组37例和预后良好组45例。比较不同组别患者的术前凝血功能指标差异,分析各凝血指标对患者预后的预测价值。结果观察组的凝血酶原时间(PT)、激活部分凝血酶原时间(APTT)、国际标准化比值(INR)、血栓调节蛋白(TM)及纤溶酶原激活物抑制剂-1(PAI-1)水平均显著高于对照组,差异有统计学意义(P<0.05)。重度组患者的PT、APTT、INR、TM、PAI-1水平高于轻中度组,差异有统计学意义(P<0.05)。与预后良好组相比,预后不良组患者的年龄更大,出血时间更长,收缩压(SBP)、舒张压(DBP)、PT、APTT、INR、TM、PAI-1水平更高,差异有统计学意义(P<0.05)。受试者工作特征(ROC)曲线分析显示,PT、APTT、INR、TM、PAI-1对高血压脑出血患者预后不良均有一定的诊断效能[曲线下面积(AUC)值均>0.7],单项指标以INR的诊断效能最高(AUC=0.833),PT最低(AUC=0.762)。与单项指标相比,5项凝血功能指标联合检测诊断患者预后不良的AUC为0.942,诊断敏感度、特异度分别为100.00%和97.22%。结论高血压脑出血患者在急诊开颅术前普遍存在不同程度的凝血功能异常,凝血功能异常与脑损伤程度及预后不良密切相关,联合检测凝血功能指标(PT、APTT、INR、TM、PAI-1)可为临床评估患者病情提供参考依据。

Objective To investigate the relationship between preoperative coagulation function and prognosis in patients with hypertensive cerebral hemorrhage undergoing emergency craniotomy.Methods Eighty-two patients with hypertensive cerebral hemorrhage who underwent emergency craniotomy(observation group)and 50 healthy volunteers(control group)were retrospectively selected as study subjects.The patients in the observation group were further divided into mild-to-moderate group(31 cases)and severe groups(51 cases)based on Glasgow Coma Score(GCS)at admission,and were divided into poor prognosis group(37 cases)and good prognosis group(45 cases)based on Glasgow Outcome Score(GOS).The differences in preoperative coagulation function indicators among different groups were compared,and the predictive value of coagulation indicators for patients′prognosis was analyzed.Results The levels of prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio(INR),thrombomodulin(TM),and plasminogen activator inhibitor-1(PAI-1)in the observation group were significantly higher than those in the control group(P<0.05).The levels of PT,APTT,INR,TM,and PAI-1 in the severe group were significantly higher than those in the mild-to-moderate group(P<0.05).Compared with the good prognosis group,patients in the poor prognosis group had older age,longer bleeding time,and higher levels of systolic blood pressure(SBP),diastolic blood pressure(DBP),PT,APTT,INR,TM,and PAI-1(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that PT,APTT,INR,TM,and PAI-1 all had certain diagnostic efficiency for poor prognosis in patients with hypertensive cerebral hemorrhage[area under the curve(AUC)values were all over 0.7],with INR of the highest diagnostic efficiency(AUC=0.833)and PT of the lowest(AUC=0.762).Compared with single indicator,the AUC of combined detection of five coagulation function indicators for diagnosing poor prognosis was 0.942,with diagnostic sensitivity and specificity of 100.00%and 97.22%,respectively.Conclusion Hypertensive cerebral hemorrhage patients generally have varying degrees of coagulation dysfunction before emergency craniotomy,and coagulation dysfunction is closely related to the degree of brain injury and poor prognosis.Combined detection of coagulation function indicators(PT,APTT,INR,TM,PAI-1)can provide a reference for clinical assessment of patients′condition.