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目的探讨颅脑损伤后患者血小板(PLT)参数的变化及其与继发性脑损害的关系。方法伤后24h内入院的非手术治疗的颅脑损伤患者163例,分别于伤后1d、3d及14d三个时间段采血测定外周血PLT数量、PLT平均体积(MPV)、PLT体积分布宽度(PDW);于入院时、伤后1d、伤后7d进行GCS评分,并通过CT计算脑出血量及脑水肿体积;伤后6个月进行GOS预后评分,分析上述指标与PLT计数、MPV和PDW之间的关系。同时测定40例健康体检者外周血的PLT计数、MPV和PDW作为对照。结果伤后1d及3dPLT计数较对照组明显下降,MPV和PDW值明显增加(P<0.05);伤后14dPLT计数、MPV和PDW值均恢复正常;GCS<8分者PLT计数明显低于GCS≥8分者,而MPV和PDW则明显高于GCS≥8分者(P<0.05);脑水肿体积伤后逐渐扩大,至伤后7d时水肿体积最大(P<0.05);脑水肿体积与PLT计数呈负相关关系(r=-0.238,P<0.05),与MPV和PDW的值呈正相关关系(r=0.642、0.593,P<0.05);GOS评分与外周血PLT计数呈正相关(r=0.883,P<0.05),而与MPV和PDW值呈负相关(r=-0.235、-0.267,P<0.05)。结论本结果提示,颅脑损伤后PLT参数的变化可能与伤后继发性脑损害有关;检测其变化有助于对颅脑损伤伤情、预后的判断,并为颅脑损伤治疗提供新思路。
Objective To investigate the changes of platelet (PLT) parameters in patients with brain injury and its relationship with secondary brain damage. Methods A total of 163 patients with craniocerebral injury who were admitted to the hospital within 24 hours after injury were enrolled in this study. Blood samples were collected from 1, 3 and 14 days after injury to determine the number of PLT, the average volume of PLT (MPV), the width of PLT ( PDW). GCS scores were recorded on admission, 1 day after injury and 7 days after injury, and the volume of cerebral hemorrhage and brain edema were calculated by CT. The GOS prognosis score was measured 6 months after injury, and the above indexes were compared with PLT, MPV and PDW The relationship between. The PLT counts of peripheral blood from 40 healthy subjects were measured at the same time. MPV and PDW were used as control. Results The levels of PLT and MPV were significantly decreased at 1 and 3 days after injury compared with the control group (P <0.05). The PLT and MPV and PDW values returned to normal on the 14th day after injury (P <0.05). The volume of brain edema enlarged gradually after injury, and the volume of edema reached the maximum at 7d after injury (P <0.05). The volume of brain edema was positively correlated with PLT (R = -0.238, P <0.05), but positively correlated with MPV and PDW (r = 0.642, 0.593, P <0.05). There was a positive correlation between GOS score and peripheral blood PLT count (r = 0.883 , P <0.05), but negatively correlated with MPV and PDW (r = -0.235, -0.267, P <0.05). Conclusion The results suggest that the changes of PLT parameters after craniocerebral injury may be related to the secondary brain injury after injury. Detecting the changes may contribute to the judgment of the injury and prognosis of craniocerebral injury, and provide new ideas for the treatment of craniocerebral injury.