摘要
目的研究幕上脑出血治疗过程中继发脑梗死的临床分析。方法研究对象为91例幕上脑出血患者,其中19例在治疗过程中发生脑梗死,此为观察组;72例治疗过程中未发生脑梗死及脑缺血事件,此为对照组。观察指标包括血栓弹力图、凝血四项、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力(ADL)量表(Barthel指数,BI)等。结果2组患者入院时、3 d查凝血四项及D-二聚体和血小板计数差异无统计学意义(P>0.05);入院时2组患者凝血对应时间(R值)、凝血形成时间(K值)、血凝块形成速率或α角(Angle)、血栓最大幅度(MA值)、CI数据比较差异无统计学意义(P>0.05);3d观察组R值、K值较对照组数值下降,MA值较对照组数值上升,差异均存在统计学意义(P<0.05),Angle、CI数据差异无统计学意义(P>0.05);第90天NIHSS评分、ADL量表显示,脑出血后继发脑梗死的患者,比对照组患者预后差,组间差异有统计学意义(P<0.05)。结论幕上脑出血急性期凝血状态复杂,治疗期间继发性脑梗死的患者,远期预后较差。相对于凝血指标,血栓弹力图指标可以更敏感地反映患者凝血状态,指导患者临床治疗方案,进而改善患者预后。
Objective To analyze the clinical data of cerebral infarction occurring in the process of treatment of supratentorial intracerebral hemorrhage.Methods The study included 91 patients with supratentorial intracerebral hemorrhage,of which 19 cases developed cerebral infarction during the course of treatment,which was the observation group;72 cases did not develop cerebral infarction and ischemic events during the course of treatment,was the control group.The observation indicators included thromboelastography(TEG),blood concretion four item,national institutes of health stroke scale(NIHSS)score,activities of daily living(ADL)scale(Barthel index,BI).Results There was no statistical difference in blood concrerion four item,D-Dimer,and platelet count between the two groups of patients at admission and 3 days(P>0.05);there was no significant difference in TEG indexes[R value(coagulation reaction time),Kvalue(coagulation time),Angle(reflecting the formation rate of blood clot and the function of fibrinogen),MA(maximum thrombus amplitude),CI(coagulation index)]at admission in the two groups of patients(P>0.05);the R value and K value of the observation group were lower than those of the control group at 3 days,and the MA was higher than that of the control group,all of which were statistically significant(P<0.05);the NIHSS score and ADL scale at day 90 showed that the patients with Delayed cerebral infarction had a worse prognosis than the control group patients(P<0.05).Conclusion The coagulation status in the acute stage of supratentorial intracerebral hemorrhage is complex,and patients who develop cerebral Infarction have a poor prognosis;compared with coagulation indicators,thromboelastography indicators can more sensitively reflect the coagulation status,guide the clinical treatment,and thus improve the prognosis of patients.
作者
李鹏
姚志刚
孙志敏
郝亮
张建辉
贾文志
武海龙
高明明
Li Peng;Yao Zhigang;Sun Zhimin;Hao Liang;Zhang Jianhui;Jia Wenzhi;Wu Hailong;Gao Mingming(Department of Neurosurgery,Shijiazhuang Third Hospital,Hebei 05001l,China)
出处
《脑与神经疾病杂志》
2025年第9期553-557,共5页
Journal of Brain and Nervous Diseases
基金
石家庄市科学技术研究与发展计划(171461633)。
关键词
脑出血
脑梗死
血栓弹力图
Cerebral hemorrhage
Cerebral infarction
Thromboelastography
