血栓弹力图评估重型颅脑创伤术后深静脉血栓的应用价值

摘要

Objective To investigate the application value of thrombelastography(TEG)in the dynamic monitoring deep vein thrombosis among patients with severe traumatic brain injury (sTBI).Methods One hundred and sixteen cases of patients with sTBI were randomly divided into 2 groups:experimental group(65 cases)and control group(51 cases).The prothrombin time (PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB), blood platelet(PLT)and thrombus elastic figure index (R,K,Angle and MA)were observed between the two groups in pre-operation and 1,3,7,14 days post-operative.TEG tests were performed in pre-operation on experimental group patients,and given low molecular weight heparin calium treatment according to the result of measuring,and continue to TEG monitoring on 1,3,7,14 days in post-operation.The control group patients were performed the traditional experiential therapy after operation according to coagulation and platelet results.Both groups of patients were separately recorded the occurrence of deep vein thrombosis by the color doppler ultrasound of lower limbs on 2 weeks.Results TT and APTT value were gradually rise in the two groups and there was statistical difference between the different points(P<0.05).PT value fluctuated in 2 groups and there was statistical difference between the different points(P<0.05). FIB value was downward trend in the two groups and there was statistical difference between groups,the different points and the interaction(P< 0.05 ).PLT value was declined in the two groups and there was statistical difference between the different points(P<0.05).The incidence of DVT was 7.69%(5/65)on experimental group,the incidence of DVT was 25.49%(13/51)on control group,the differences were statistically significant(χ2 =6.905,P<0.05).Conclusion TEG has a higher application value in monitoring deep vein thrombosis after severe traumatic brain injury compared with conventional coagulation routine test.%目的 分析血栓弹力图(thrombelastograph,TEG)在动态监测重型颅脑创伤患者术后深静脉血栓形成(deep vein thrombosis,DVT)中的应用价值.方法 将116例重型颅脑创伤手术后患者随机分为实验组65例和对照组51例.观察2组术前、术后第1天、术后第3天、术后第7天、术后第14天凝血酶原时间(prothrombintime,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(Fibrinogen,FIB)和血小板(blood platelet,PLT)和血栓弹力图指标R值、K值、Angle值和MA值的变化.实验组于术前进行TEG监测,根据测量结果 进行低分子肝素钙处理,并于术后第1天、第3天、第7天和第14天进行TEG监测.对照组则根据术前凝血常规和血小板结果进行经验性术后治疗处理.2组术后均进行常规治疗和护理,于术后2周经双下肢彩色多普勒超声检查记录DVT发生情况.结果2组TT、APTT值均逐渐升高,其不同时点间差异有统计学意义(P<0.05);2组PT值上下波动,其不同时点间差异有统计学意义(P<0.05);2组FIB值呈下降趋势,其组间、时点间以及组间·时点间交互作用差异均有统计学意义(P<0.05);2组PLT值呈逐渐下降趋势,其不同时点间差异有统计学意义(P<0.05).实验组DVT发生率为7.69%(5/65),对照组DVT发生率为25.49%(13/51),实验组DVT发生率明显低于对照组,差异有统计学意义(χ2=6.905,P<0.05).结论TEG动态监测较凝血常规实验对预防重型颅脑创伤术后并发DVT的应用价值更大.