苗旺,赵珂,郭俊爽,张书语,申楠楠,王慧彬,荆婧,黄培培,张丽娜,滕军放

• 1:郑州大学第一附属医院
• 2:平顶山市第一人民医院

摘要(Abstract)：

目的动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)后凝血功能异常影响患者预后。探讨aSAH首日患者凝血功能变化,并分析其与反映意识障碍程度的相关性。为重症aSAH患者首日精细化管理提供参考。方法 40例发病24 h内入住神经重症监护室的aSAH患者,与20例年龄、性别相匹配的健康对照组进行比较。对血栓弹力图(thrombelastography,TEG)结果、GCS评分进行分析;根据入院时GCS评分进行亚组分析,比较GCS≤7和GCS>7亚组TEG各项结果;并分析其与GCS的相关性。结果与对照组比较,aSAH患者首日反应凝血因子功能的TEG-R值明显降低(4.18±1.54 vs 6.61±0.95,P=0.001);纤溶系统(LY30、EPL)和其他指标(MA、K、Angel)、常规凝血功能差异无统计学意义(P>0.05)。GCS≤7亚组较GCS>7亚组TEG-R值也明显降低(3.32±1.04 vs 5.24±1.41,P<0.001),且TEG-R与GCS评分具有相关性(r=0.551,P<0.001)。结论 aSAH首日患者凝血因子功能增强的高凝状态,尤其是GCS≤7的患者,且与GCS高度相关;但纤溶系统无明显变化。

关键词(KeyWords)： 蛛网膜下腔出血;血栓弹力图;凝血因子;纤溶系统;凝血异常

Abstract:

Keywords:

基金项目(Foundation): 河南省高等学校重点科研项目(编号:17A320067);; 河南省医学科技攻关计划联合共建项目(编号:LHGJ20190087)

作者(Author): 苗旺,赵珂,郭俊爽,张书语,申楠楠,王慧彬,荆婧,黄培培,张丽娜,滕军放

参考文献(References)：

• [1] LIANG C W,SU K,LIU J J,et al.Timing of deep vein thrombosis formation after aneurysmal subarachnoid hemorrhage[J].J Neurosurg,2015,123(4):891-896.DOI:10.3171/2014.12.JNS141288.
• [2] MIAO W,ZHAO K,DENG W,et al.Coagulation Factor Hyperfunction After Subarachnoid Hemorrhage Induces Deep Venous Thrombosis[J].World Neurosurg,2018,110(3):46-52.DOI:10.1016/j.wneu.2017.09.200.
• [3] XIN Z L,WU X K,XU J R,et al.Arachnoid cell involvement in the mechanism of coagulation-initiated inflammation in the subarachnoid space after subarachnoid Hemorrhage[J].J Zhejiang Univ Sci B,2010,11(7):516-23.DOI:10.1631/jzus.B1000099.
• [4] EL-KHAWAS K,LLOYD-DONALD P,HART G K,et al.Prospective Longitudinal Evaluation of Coagulation with Novel Thromboelastography Technology in Patients After Subarachnoid Hemorrhage:A Pilot Study[J].World Neurosurg,2020,136:e181-e195.DOI:10.1016/j.wneu.2019.12.109.
• [5] 张国栋,程振国,孙来广.长期口服阿司匹林的高血压脑出血患者术前输血的意义[J].中国实用神经疾病杂志,2017,20(8):118-119.DOI:10.3969/j.issn.1673-5110.2017.08.053.
• [6] 王觅,赵幸娟.颈动脉粥样硬化与血栓弹力图相关性的研究[J].中国实用神经疾病杂志,2018,21(7):89-93.DOI:10.12083/SYSJ.2018.07.194.
• [7] YOO S H,VENN E,SULLIVAN L A,et al.Thromboelastographic evidence of inhibition of fibrinolysis after epsilon-aminocaproic acid administration in a dog with suspected acute traumatic coagulopathy[J].J Vet Emerg Crit Care (San Antonio),2016.26(5):737-742.DOI:10.1111/vec.12467.
• [8] MEYER C H,LOWE D,MEYER M,et al.Progressive change in cerebral blood flow during the first three weeks after subarachnoid hemorrhage[J].Neurosurgery,1983,12(1):58-76.DOI:10.1227/00006123-198301000-00010.
• [9] HE Q G,ZHOU Y,LIU C,et al.Thromboelastography with Platelet Mapping Detects Platelet Dysfunction in Patients with Aneurysmal Subarachnoid Hemorrhage with Rebleeding[J].Neuropsychiatr Dis Treat,2019,15(12):3443-3451.DOI:10.2147/NDT.S229284.
• [10] FOREMAN P M,CHUA M,HARRIGAN MR,et al.Antifibrinolytic therapy in aneurysmal subarachnoid hemorrhage increases the risk for deep venous thrombosis:A case-control study[J].Clin Neurol Neurosurg,2015,139(9):66-69.DOI:10.1016/j.clineuro.2015.09.005.
• [11] KHAN M T,IKRAM A,SAEED O,et al.Deep Vein Thrombosis in Acute Stroke-A Systemic Review of the Literature[J].Cureus,2017,9(12):1982.DOI:10.7759/cureus.1982.
• [12] IPLIKCIOGLU A C,BERKMAN M Z.The effect of short-term antifibrinolytic therapy on experimental vasospasm[J].Surg Neurol,2003,59(1):10-16;discussion 16-17.DOI:10.1016/s0090-3019(02)00867-4.
• [13] PAYDAR S,SABETIAN G,KHALILI H,et al.Management of Deep Vein Thrombosis (DVT) Prophylaxis in Trauma Patients[J].Bulletin of emergency and trauma,2016,4(1):1-7.
• [14] MACDONALD R L,SCHWEIZER T A.Spontaneous subarachnoid haemorrhage[J].Lancet,2017,389(10069):655-666.DOI:10.1016/S0140-6736(16)30668-7.
• [15] LECHER I,WANG D S,ROMASCHIN A D,et al.Tranexamic acid concentrations associated with human seizures inhibit glycine receptors[J].J Clin Invest,2012.122(12):4654-4666.DOI:10.1172/JCI63375.
• [16] MALEKPOUR M,KULWIN C,BOHNSTEDT BN,et al.Effect of short-term ε-aminocaproic acid treatment on patients undergoing endovascular coil embolization following aneurysmal subarachnoid hemorrhage[J].J Neurosurg,2017,126(5):1606-1613.DOI:10.3171/2016.4.JNS152951.
• [17] KOUPENOVA M,KEHREL B E,CORKREY H A,et al.Thrombosis and platelets:an update[J].Eur Heart J,2017,38(11):785-791.DOI:10.1093/eurheartj/ehw550.