硬膜下血肿中的血小板滑液综合征。

Slippery platelet syndromes in subdural hematoma.

机构信息

Department of Neurosurgery, University of California, San Francisco, CA, USA.

出版信息

Neurocrit Care. 2010 Jun;12(3):375-81. doi: 10.1007/s12028-010-9336-3.

DOI:10.1007/s12028-010-9336-3

PMID:20151335

Abstract

BACKGROUND

This study investigates platelet dysfunction in patients with subdural hematomas (SDH) using platelet function analysis (PFA).

METHODS

PFA using the PFA-100 (Dade International Inc., Miami, FL) was performed at admission using the collagen-epinephrine and collagen-ADP assays in 58 SDH patients. Clinical and radiologic information was collected.

RESULTS

Normal PFA results were present in 36 patients (62%; PFA collagen:epinephrine assay (s) 118 ave; PFA collagen:adenosine diphosphate assay (s) ave 75) and abnormal platelet function in 22 patients (38%; PFA collagen:epinephrine assay (s) 231 average; PFA collagen:adenosine diphosphate assay (s) 124 average). Compared to patients with normal PFA results, patients with abnormal PFA results were more likely to have hypertension (22 vs. 55%; P = 0.01), take clopidogrel (3 vs. 32%; P = 0.001), and use anti-platelet medications and non-steroidal anti-inflammatory agents (22 vs. 59%; P = 0.004). Measurements of baseline CT for midline shift, maximum thickness, presence of blood/fluid levels in the hematoma, and presence of additional sites of intracranial bleeding did not reveal significant differences based on PFA testing. Platelet dysfunction improved after platelet transfusions (PFA collagen:epinephrine assay: baseline 270 s, CI 61 s; after transfusion 124 s, CI 50 s, P < 0.001).

CONCLUSION

Platelet dysfunction was found in 38% of SDH patients. This finding adds to our understanding of the pathophysiology of SDH. Since platelet transfusions are indicated for platelet dysfunction accompanied by major bleeding or need for surgery, these results impact peri-operative management.

摘要

背景

本研究使用血小板功能分析（PFA）对硬膜下血肿（SDH）患者的血小板功能障碍进行研究。

方法

对 58 例 SDH 患者入院时使用 PFA-100（Dade International Inc.，迈阿密，FL）进行 PFA，采用胶原-肾上腺素和胶原-二磷酸腺苷检测。收集临床和影像学信息。

结果

36 例患者（62%）PFA 结果正常（PFA 胶原：肾上腺素检测（s）118 平均；PFA 胶原：二磷酸腺苷检测（s）75 平均），22 例患者（38%）血小板功能异常（PFA 胶原：肾上腺素检测（s）231 平均；PFA 胶原：二磷酸腺苷检测（s）124 平均）。与 PFA 结果正常的患者相比，PFA 结果异常的患者更可能患有高血压（22% vs. 55%；P = 0.01），服用氯吡格雷（3% vs. 32%；P = 0.001），以及使用抗血小板药物和非甾体抗炎药（22% vs. 59%；P = 0.004）。根据 PFA 检测，中线移位、最大厚度、血肿内血液/液体水平存在以及颅内出血的其他部位存在的基线 CT 测量值没有显示出显著差异。血小板输注后血小板功能障碍得到改善（PFA 胶原：肾上腺素检测：基线 270 s，CI 61 s；输注后 124 s，CI 50 s，P <0.001）。