吴丽娟

[摘要] 目的 分析D-二聚体水平对自发性脑出血早期血肿扩大造成的影响。方法 回顾性分析该院2015年3月—2017年3月收治的96例脑出血患者临床资料，所有患者入院后立即进行头颅CT检查，发病24 h内再次头颅CT复查，根据患者是否出现早期血肿扩大随机分为血肿扩大组（20例）和血肿未扩大组（76例），检测两组患者血浆D-二聚体水平，分析其与脑出血早期血肿扩大之间的关系。结果 血肿扩大组患者中线移位率（35.0%）高于血肿未扩大组（19.7%），血肿扩大组患者血肿形状规则率（45.0%）低于血肿未扩大组（69.7%），血肿扩大组患者脑出血量（19.4±10.1）mL、D-二聚体水平（1.5±0.5）mg/L均明显高于血肿未扩大组（13.7±4.9）mL、（0.2±0.2）mg/L。经Logistic回归分析，初始脑出血量、D -二聚体和血肿扩大密切相关。 结论 D-二聚体水平升高会增加自发性脑出血早期血肿扩大风险，应引起高度重视。

[关键词] 自发性脑出血；早期血肿扩大；D-二聚体；影响分析

[中图分类号] R743 [文献标识码] A [文章编号] 1674-0742（2017）07（c）-0027-03

[Abstract] Objective To analyze the effect of D- two dimer level on the Early enlargement of hematoma of Spontaneous cerebral hemorrhage. Methods 96 cases of patients with cerebral hemorrhage admitted and treated in our hospital from March 2015 to March 2017 were selected and all patients were given the head CT examination and given the head CT reexamination in 24h after onset and the patients were divided into the hematoma enlargement group with 20 cases and hemorrhage non-enlargement group with 76 cases， and the D- two dimer level of the two groups was tested and the correlation with the early hemorrhage enlargement was analyzed. Results The centerline translocation rate in the hemorrhage enlargement group was higher than that of hemorrhage non-enlargement group（35.0% vs 19.7%）， and the hemorrhage shape regular rate in the hemorrhage enlargement group was lower than that in the hemorrhage non-enlargement group（45.0% vs 69.7%）， and the cerebral hemorrhage and D- two dimer level were obviously higher than those in the hemorrhage non-enlargement group， [（19.4±10.1）mL， （1.5±0.5）mg/L vs （13.7±4.9）mL， （0.2±0.2）mg/L]， and the Logistic regression analysis showed that the initial cerebral hemorrhage and D- two dimer were closely correlated with the hemorrhage enlargement. Conclusion The increase of D- two dimer level can increase the spontaneous cerebral hemorrhage early hemorrhage enlargement risks and we should attach high importance to it.

[Key words] Spontaneous cerebral hemorrhage； Early hemorrhage enlargement； D- two dimer； Analysis of effect

根据相关数据统计表明[1]，大概30.1%～40.3%左右急性入院患者是自发性脑出血血腫体积显著扩大患者，通常情况下，入院后前几个小时主要会出现早期血肿体积扩大现象，但是相对于其他类型卒中而言，自发性脑出血血肿扩大患者的病死率更高，而且预后相对较差[2]。为此，早期发现自发性脑出血血肿扩大尤为重要。近年来很多学者已经研究证实[3]，患者早期临床表现、脑出血初始血肿体积、有没有使用抗凝药物等都是导致血肿体积扩大的相关危险因素，但是这些因素都不是定量指标，因此非常有必要借助血清生物标记物等简单易行的方法预测自发性脑出血是否出现早期血肿扩大。……