颅脑损伤急性期血小板参数的变化及其与继发性脑损害的关系

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＝642、0．593，P〈0．05）；GOS评分与外周血PLIT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。

Changes in Platelet Parameter and Their Relationship with Secondary Brain Injury in Patients with Acute Craniocerebral Trauma

Objectives To explore the changes in platelet parameter and their relationship with secondary brain injury in the patients with acute craniocerebral trauma. Methods The number of platelet （PLT）, mean PLT volume（MPV）, PLT distribution width （PDW） were detected 1, 3 and 14 days after the injury in 163 patients with actue craniocerekral trauma admitting into the hospital 24 hours after the injury, who were conservatively treated only. GCS in all the patients was detarmined on admission, and 1 and 7 days after the injury. The volumes of cerebral hemorrhage and edema were calculated by CT. G OS in all the patients was determined 6 months after the injury. The relationships of the PLT parameter with GCS, GOS and the volumes of cerebral hemorrhage and edema were analyzed. The PLT, MPV and PDW in 40 healthy subjects served as control. Results The number of PLT decreased significantly, MPV and PDW increased significantly 1 and 3 days after the injury in the patients with craniocerebral trauma, especially in the patients with traumatic cerebral infarction, compared with the control group （P〈0.05）. The number of PLT, MPV and PDW returned to normal 14 days after the injury. The number of PLT was significantly lower and MPV and PDW were significantly higher in the patients with GCS 〈8 than the those in the patients with GCS ≥8 （P〈0.05）. The volume of cerebral edema was negatively related with the number of PLT （r=-0.238, P〈O.05） and positively with MPV and PDW （r=0.642, 0.593, respectively; P〈0.05）. GOS was positively related with the number,of PLT （r=0,883, P〈0.05） and were negatively with MPV and PDW （r=-0.235, -0.267, respectively, P〈0.05）. Conclusions It is suggested that the detection of the changes in PLT parameter, which were related with the secondary brain injury, is helpful to the judgment of injurious severity and prognosis in the patients with acute craniocerebral trauma. The present results may provide a new idea for treatment of acute eraniocerebral trauma.