高血压脑出血患者血浆凝血酶与脑水肿关系研究

目的探讨高血压脑出血凝血酶与脑水肿形成之间的关系。方法65例高血压脑出血患者按治疗方法分为常规组和微创组，两组均检测1d、3d、5d和7d外周血的凝血酶浓度，同时行头部CT以计算脑水肿、血肿体积；微创组还测定血肿液中的凝血酶活性。结果常规组和微创组3d时的外周血凝血酶浓度均显著升高分别为（5．09±1．05）IU／L和（5．10±1．04）IU／L]，微创组3d时血肿液凝血酶活性较1d、5d、7d显著升高为（7．68±1．49）IU／L（P〈0．05）；常规组3d和5d时水肿比值较1d．7d显著升高分别为（0．72±0．15）和（0．76±0．17）（P〈0．05）；微创组3d时水肿比值较1d、5d、7d显著升高（0．70±0．14）（P〈0．05）；常规组5d和7d时的水肿比值分别为（0．76±0．17）和（0．52±0．14），均显著高于微创组（P〈0．05）；直线相关分析显示：外周血凝血酶活性和脑水肿比值呈显著正相关（r=0．689，P〈0．05）；血肿液凝血酶活性和脑水肿比值亦呈显著正相关（r=0．653，P〈0．05）。结论凝血酶可导致脑出血后脑水肿形成，微创治疗有助于改善脑出血后期（〉3d）的脑水肿状况。

Study on the relationship between thrombin and cerebral edema of hypertensive intracerebral hemorrhage

Objective To investigate the relationship between thrombin and cerebral edema of hypertensive intracerebral hemorrhage. Methods 65 patients with hypertensive intracerebral hemorrhage were divided into conventional group and minimally invasive group according to treatment methods,two groups were detected the thrombin concentration of peripheral blood in 1st day,3rd day,5th and 7th day and brain CT were scanned to calculate edema and hematoma volume;meanwhile,patients in minimally invasive group were detected the thrombin concentration of hematoma fluid in 1st day ,3rd day ,5th and 7th day. Results The thrombin concentration in peripheral blood of two groups in 3rd day were significantly increased(5.09 ± 1.05) IU/L and(5.10 ±1.04) IU/L respectively,the thrombin concentration in hematoma fluid of minimally invasive group in 3rd day was significantly increased(7.68 ± 1.49) IU/L and there were significant differences between them with those of 1st day ,5 th and 7 th day(P＜0.05) ;the edema ratio of conventional group at 3rd day and 5th day (0. 72 ± 0. 15 and 0. 76 ± 0. 17 respectively) were significantly higher than those of 1 st day and 7 th day, the differences were statistically significant ( P ＜ 0.05 ) ; the edema ratio of minimally invasive group at 3rd day(0. 70 ±0.14) was significantly higher than those of 1st day,5th day and 7th day,the difference was statistically significant(P＜ 0.05) ;the edema ratio of conventional group at 5th day and 7th day were (0.76 ±0. 17) and(0. 52 ±0. 14) respectively which were significantly higher than those of minimally invasive group, the differences were statistically significant (P ＜ 0. 05); linear correlation analysis showed: the thrombin concentration of peripheral blood was positively correlated to the edema ratio( r = 0.689, P ＜ 0.05 ) ;the thrombin concentration of hematoma fluid was also positively correlated to the edema ratio ( r = 0. 653, P＜0.05 ). Conclusion Thrombin could lead to the formation of brain edema after intracerebral hemorrhage,minimally invasive treatment could help to speed up the subside of cerebral edema in late period ( ＞3d)of intracerebral hemorrhage.