摘要
目的 探讨颅脑损伤合并多发伤患者血栓弹力图与预后的关系。方法 回顾性分析2019-01—2022-05中国人民解放军勤联保障部队第909医院258例颅脑损伤合并多发伤患者的一般资料。收集患者刚入院时损伤严重程度评分(ISS)、格拉斯哥昏迷评分(GCS)、急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分、血栓弹力图(TEG)等相关资料。按患者受伤后90 d临床结局分为生存组及死亡组,比较2组TEG相关指标的变化。采用Logistic回归模型分析颅脑损伤合并多发伤患者预后的影响因素,采用受试者工作特征(ROC)曲线分析TEG对预后的预测价值。结果 与生存组比较,死亡组凝血酶时间(TT)明显较短,活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)明显较长,血小板计数、GCS评分明显较低,ISS及APACHEⅡ评分明显较高(P<0.05)。与生存组比较,死亡组凝血块形成时间(K)、反应时间(R)明显较长,最大血块强度(MA)、凝血综合指数(CI)及细胞凝集块形成速率(α角)明显较低(P<0.05)。Logistic多因素回归分析显示,MA值是颅脑损伤合并多发伤患者预后的独立危险因素(P<0.05)。MA对颅脑损伤合并多发伤患者预后价值的AUC为0.762,最大约登指数为0.586(P<0.05)。结论 颅脑损伤合并多发伤患者TEG相关指标可发生明显异常,MA值对患者预后有一定预测价值。
Objective To investigate the relationship between thromboelastogram and prognosis in patients with craniocerebral injury combined with multiple injuries.Methods The general data of 258 patients with craniocerebral injury combined with multiple injuries in 909th Hospital of PLA Support Force from January 2019to May 2022 were analyzed retrospectively.The data of injury severity score(ISS),Glasgow coma score(GCS),acute physiology and chronic health assessment Ⅱ(APACHE Ⅱ)score,thromboelastogram(TEG)and other relevant data were collected.The patients were divided into survival group and death group according to the clinical outcome 90 days after injury,and the changes of TEG related indicators in the two groups were compared.Logistic regression model was used to analyze the prognostic factors of patients with craniocerebral injury combined with multiple occurrence.The predictive value of TEG related indexes on the prognosis was analyzed by using ROC curve.Results Compared with the survival group,the dead group had shorter thrombin time(TT),longer activated partial thromboplastin time(APTT)and prothrombin time(PT),lower platelet count and GCS score,and higher ISS and APACHE Ⅱ score(P<0.05).Compared with the survival group,the clot formation time(K),reaction time(R),maximum clot strength(MA),coagulation comprehensive index(CI)and cell clot formation rate in the death group were significantly longer(α angle)was significantly lower(P<0.05).Logistic multivariate regression analysis showed that MA value was an independent risk factor for the prognosis of patients with brain injury combined with multiple injuries(P<0.05).The AUC of MA in the prognosis of patients with craniocerebral injury combined with multiple injuries was 0.762,and the maximum Yoden index was 0.586(P<0.05).Conclusion TEG related indexes in patients with craniocerebral injury combined with multiple injuries can be significantly abnormal,and MA value has a certain predictive value for the prognosis of patients.
作者
郑雪峰
罗飞
黄巍
李君
张明升
汤志辉
王文浩
ZHENG Xuefeng;LUO Fei;HUANG Wei;LI Jun;ZHANG Mingsheng;TANG Zhihui;WANG Wenhao(909th Hospital of the Joint Logistic Support Force,Zhangzhou 363000,China;Southeast Hospital Affiliated to Xiamen University,Zhangzhou 363000,China)
出处
《中国实用神经疾病杂志》
2023年第4期448-452,共5页
Chinese Journal of Practical Nervous Diseases
基金
福建省自然科学基金资助项目(编号:2015J05119)。
关键词
颅脑损伤
多发伤
血栓弹力图
凝血功能
预后
Brain injury
Multiple injury
Thrombus elastogram
Coagulation function
Prognosis
作者简介
通信作者:王文浩。
