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目的探讨中型和重型颅脑损伤后患者血小板(platelet,Plt)参数的变化特点及临床意义。方法选取2009年3月-2010年3月脑外伤后24 h内入院的颅脑损伤患者75例作为观察组,于伤后1、3、7、14 d采血测定Plt数量、血小板平均体积(mean platelet volume,MPV)、血小板体积分布宽度(platelet distribution width,PDW),并同时进行格拉斯哥昏迷评分(Glasgow coma scale,GCS)。同时选取60例健康体检者,测定Plt、MPV和PDW作为对照组。结果观察组伤后1、3、7 d Plt计数分别为(106.21±36.31)、(102.76±35.23)、(108.37±31.32)×109/L,较对照组[(210.41±68.56)×109/L]明显降低(P<0.05);观察组伤后1、3、7 d MPV分别为(12.34±1.34)、(11.21±1.52)、(10.78±1.36)fL,PDW分别为(15.78±1.26)、(17.67±1.16)、(16.72±1.21)fL,均较对照组[MPV:(8.24±1.76)fL,PDW:(12.86±1.42)fL]明显升高(P<0.05);伤后14 d Plt、MPV和PDW均较对照组差异无统计学意义(P>0.05)。GCS≤8分组伤后1 d Plt计数为(96.85±36.52)×109/L,明显低于GCS>8分组[(123.85±35.78)×109/L],而GCS≤8分组MPV为(12.14±1.32)fL,PDW为(18.63±1.21)fL,均明显高于GCS>8分组[MPV:(9.78±1.34)fL,PDW:(16.72±1.34)fL],差异均有统计学意义(P<0.05)。伤后第1天Plt与随访6个月GOS评分呈正相关(r=0.625,P<0.05)。结论中型和重型颅脑损伤后Plt计数明显降低,MPV和PDW值明显升高,且与伤情及预后有关。Plt及其参数的检测有助于对伤情、预后的判断。
Objective To investigate the characteristics and clinical significance of platelet (Plt) parameters in patients with moderate and severe traumatic brain injury. Methods Seventy-five patients with craniocerebral injury who were hospitalized within 24 h after traumatic brain injury from March 2009 to March 2010 were selected as the observation group. Plt quantity, mean platelet volume (mean platelet volume (MPV), platelet distribution width (PDW) and Glasgow coma scale (GCS). At the same time, 60 healthy subjects were selected to determine Plt, MPV and PDW as control group. Results The counts of Plt on the 1st, 3rd, 7th day in the observation group were (106.21 ± 36.31), (102.76 ± 35.23) and (108.37 ± 31.32) × 109 / L, respectively, which were significantly higher than those in the control group [(210.41 ± 68.56) × 109 / L (P <0.05). The MPV in the observation group were (12.34 ± 1.34), (11.21 ± 1.52), (10.78 ± 1.36) fL and PDW were (15.78 ± 1.26), (17.67 ± 1.16) and (16.72 ± 1.21) fL, respectively, compared with control group [MPV: (8.24 ± 1.76) fL and PDW: (12.86 ± 1.42) fL] There were no significant differences in MPV and PDW between the two groups (P> 0.05). The counts of Plt on the first day after GCS≤8 were (96.85 ± 36.52) × 109 / L, significantly lower than those of GCS> 8 [(123.85 ± 35.78) × 109 / L], while those of GCS≤8 were (12.14 ± 1.32) fL and PDW were (18.63 ± 1.21) fL, which were significantly higher than those of GCS> 8 group [MPV: (9.78 ± 1.34) fL and PDW: (16.72 ± 1.34) fL, respectively] 0.05). There was a positive correlation between Plt on the first day after injury and GOS score at 6 months follow-up (r = 0.625, P <0.05). Conclusions The counts of Plt decreased and the values of MPV and PDW increased significantly in moderate and severe traumatic brain injury, which were related to the injury and prognosis. The detection of Plt and its parameters help to judge the injury and prognosis.