脑出血患者血栓弹力图试验指标变化的分析

Analysis of thrombelastography index in patients with cerebral hemorrhage

目的通过对脑出血患者血栓弹力图(TEG)试验指标的检测,结合其发病机制分析其变化规律,分析脑出血患者应用TEG试验指标评估病情的可行性,为脑出血的诊治寻找客观的实验室指标。方法收集脑出血患者33例(脑出血组),按出血量分为小量亚组11例、中量亚组16例、大量亚组6例。另选择健康成人20例为对照组。受试对象完善TEG检查前均未进行药物或手术干预治疗。诊断以颅脑CT和MRI检查为主,CT评估脑出血量,应用北京中兴TEG YZ5000型弹力图仪检测TEG指标(R值、K值、angle、MA值、CI)。结果脑出血组K值高于对照组,Angle、MA低于对照组,差异均有统计学意义(P<0.05)。3亚组间CI比较差异无统计学意义(P>0.05);R值<10ml亚组、10~30ml亚组低于>30ml亚组(P<0.05),K值、Angle、MA 3亚组间两两比较均有差异(P<0.05)。脑出血组内K值、Angle、MA与脑出血量均有显著相关性(r=0.613、-0.481、-0.381,P值均<0.05);R值、CI与脑出血量无显著相关性(r=0.251、0.242,P>0.05)。结论 TEG能够动态且完整地反映凝血与纤溶的整个过程,K值、Angle与MA值可以作为监测脑出血患者凝血功能的一个新选择。

Objective To detect the TEG of patients with cerebral hemorrhage,combined with its pathogenesis and change law. To analyze the feasibility of using TEG test to assess the condition of patients with cerebral hemorrhage,in order to find the laboratory indexes for the diagnosis and treatment of cerebral hemorrhage. Methods Selected 33 cases patients with cerebral hemorrhage as cerebral hemorrhage group. According to the amount of bleeding,33 cases patients were divided into small subgroup of 11 cases,moderate subgroup of 16 cases,large subgroup of 6 cases. Selected 20 cases healthy adults as control group. No drug or surgical intervention was performed before TEG examination. CT and MRI were the main diagnoses. CT was used to measure cerebral hemorrhage. TEG index( R value,K value,angle,MA value,CI) was detected by Beijing Zhongxing TEG YZ5000 instrument. Results The K value of cerebral hemorrhage group was higher than that of the control group,while Angle and MA were lower than the control group( P < 0. 05). There was no significant difference in CI among 3subgroups( P > 0. 05). R value < 10 ml subgroup,10 ~ 30 ml subgroup were lower than > 30 ml subgroup( P < 0. 05). K value,Angle,MA among 3 subgroups was different( P < 0. 05). There were significant correlations between the values of K,Angle,MA and cerebral hemorrhage( r = 0. 613,- 0. 481,- 0. 381,P < 0. 05),R value,CI and cerebral hemorrhage was no significant correlation( R = 0. 251,0. 242,P > 0. 05). Conclusion TEG can dynamically and completely reflect the whole process of coagulation and fibrinolysis. K value,Angle and MA value can be used as a new choice to monitor coagulation function of patients with cerebral hemorrhage.