围手术期血浆d -二聚体在脑肿瘤术后脑出血中的作用:一项前瞻性研究

Jordán Estela Val, Puertas Agustín Nebra, Pellejero Juan Casado, López Concepción Revilla, Monsteirín Nuria Fernández, Goixart Lluis Servia, Díaz Manuel Quintana
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引用次数: 0

摘要

背景:脑出血是脑肿瘤手术后最可怕的并发症之一。尽管有几个因素被认为会影响出血,但越来越多的临床研究强调,在手术侵袭和肿瘤状态期间发生的止血障碍可以解释意外的脑出血。本前瞻性研究的目的是评估围手术期d -二聚体水平对脑肿瘤术后脑出血的影响。方法:这项前瞻性、观察性、为期18个月的研究,在一家三甲医院进行,包括所有连续接受脑肿瘤手术并术后在重症监护病房住院的成年人。三份血液样本评估d -二聚体水平(a基线,b术后和c术后24小时)。考虑的正常范围为0-500ng/ml。脑出血,作为主要结局,被定义为出血,在术后24小时的常规CT扫描中通过体积或质量效应产生颅内高压的放射学征象。分析其他肿瘤特征及止血指标。定性变量的推理分析采用χ 2和Fisher精确检验,定量变量的推理分析采用Wilcoxon和t检验。p值< 0.05为显著性,置信区间为95%。结果:最终纳入109例脑肿瘤手术患者,其中男性69例(63,30%),女性40例(36,70%),平均年龄(54,60±14,75)岁。确诊脑出血39例(35.78%)。DDimer的平均值为A-1.526,70 ng/dl, B-1.061,88 ng/dl, C-1.330,91 ng/dl (A p0.039, B p0.0223, C p0.042, W-Wilcoxon检验)。男性组也与ICH相关(p0.030 X2检验)。39例脑出血患者中,A组30例(76.9%),B组20例(51.28%),C组35例(89.74%)d -二聚体> 500 ng/dl (X2检验p0,092, p1, p0,761),患者术后发生血肿的相对风险术前增加0.36倍,术后增加0.25倍,术后24小时增加0.40倍。d -二聚体差异无统计学意义(p0,118, p0,195, p0,756 t检验)。血小板和凝血酶原活性仅在样品A中与d -二聚体水平相关(p 0.02和p 0.02, W Wilson)。结论:围手术期高水平的d -二聚体可作为脑肿瘤术后脑出血的危险标志。然而,需要更多的研究来证实这种关联,并制定中风的初级预防策略。
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Role of perioperative plasma D-dimer in intracerebral hemorrhage after brain tumor surgery: A prospective study
Background: Intracerebral hemorrhage (ICH) is one of the most feared complications after brain tumor surgery. Despite several factors being considered to influence bleeding, an increasing number of clinical studies emphasize that hemostatic disorders, developed during surgical aggression and tumor status, could explain unexpected ICH. The objective of this prospective study was to evaluate the influence of perioperative D-dimer levels on ICH after brain tumor surgery. Methods: This prospective, observational, 18-month study, at a single third-level hospital, included all consecutive adults operated on brain tumors and postoperative stay in an intensive care unit. Three blood samples evaluated D-dimer levels (A-baseline, B-postoperative and C-24 hours after surgery). The normal range considered was 0-500ng/ml. ICH, as a primary outcome, was defined as bleeding that generates radiological signs of intracranial hypertension either by volume or by mass effect on the routine CT scan 24 hours after surgery. Other tumor features and hemostasis variables were analyzed. Chi-squared and Fisher’s exact test were used in the inferential analysis for qualitative variables and Wilcoxon and T-Test for quantitative ones. P-value < 0.05 was considered significant for a confidence interval of 95%. Results: A total of 109 patients operated on brain tumor surgery were finally included, 69 male (63,30%) and 40 female (36,70%), with a mean age of 54,60 ± 14,75 years. ICH was confirmed in 39 patients (35,78%). Their average of DDimer was A-1.526,70 ng/dl, B-1.061,88 ng/dl, and C-1.330,91 ng/dl (A p0.039, B p0,223 C p0.042, W-Wilcoxon test). The male group was also associated with ICH (p0,030 X2 test). Of those 39 patients with ICH, 30 in sample A (76,9%), 20 in sample B (51,28%) and 35 in sample C (89,74%) had a D-dimer > 500 ng/dl (p0,092, p1, p0,761 X2 test) and the relative risk of developing a postoperative hematoma in this patients was increased 0,36-fold presurgery, 0,25-fold postsurgery and 0,40-fold 24hours after surgery. D-dimer variation, had no statistical significance (p0,118, p0,195, p0,756 T-test). Platelets and prothrombin activity were associated with D-dimer levels only in sample A (p 0,02 and p 0,20, W Wilson). Conclusion: High levels of perioperative D-dimer could be considered a risk marker of ICH after brain tumor surgery. However, more studies would be worthwhile to confirm this association and develop primary prevention strategies for stroke.
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