| Objective: To observe the level of plasma's d-dimer(DDI) of patients in the healing process of hypertensive cerebral hemorrhage(HICH), we reasearch the relationships between the change of plasma's DDI in patients of HICH and admission condition of patients, selection of treatment, prognosis.Methods: 1.Patient selection: 76 patients related to HICH were treated in Yanan university afflilated hospital from 2009, October to 2010, Setemper, including 39 males and 37 females, age from 34 to 86 years old, average age of 58.92±13.20 years old. Time is between 3 hours and 15 hours from onset to admission, average time of 8.01±3.12 hours. Bleeding reason: hypertension. They have a history of hepertension between 3 to 30 years, blood pressure is 154—210/90—118mmHg(1 mmHg=0.133kPa)。2. Test methods: We can tell the condition of patients to their family members and explore merit and demerit about craniotomy hematoma removal, brain ventricle puncture and nonoperative treatment.we divided all the cases to three groups including caniotomy hematoma removal group(27cases), brain ventricle puncture group(25cases) and nonoperative treatment group(24cases) according the condition of patients and their family members'wishes when we got their consent. The control group include 20 cases of the heathy check-up during the same term. The level of DDI in plasm of Patients of every group with onset of HICH were measured on the 1st d, 3th d, 4th d, 7th d, 14th d, 21th d, and 30th d. At the same time, the GCS scores of admission, amout of brain bleeding and whether hemorrhage ingress the cerebral ventricle or not were recorded. The GOS scores of discharged patients or death were evaluated.Result: The level of DDI in plasm on admission were higher than the control group's. The level of DDI in the caniotomy hematoma removal group's patients began to step up on the 1st d, achieved to the maximum on the 3th d, gradually decreased on the 4th d, restored to normal level one month later. The level of DDI in the brain ventricle puncture group's patients also began to step up on the 1st d, but steped up evidently on the 3th d and 4th d, attained to the maximum through one week and began to decrease, restored to normal level one month later. The variation of DDI level in plasm in the nonoperative treatment group is similar to ventricle puncture group, but the peak amplitude at the same time is higher than ventricle puncture group except the 1st d. The level of DDI in plasm in every group is compared each other at the same time. They all obeyed gaussian distribution though testing and were tested through measurements and analysis of variance. Every group with the control group had significant difference(p<0.05) except 30th d. On the 1st d, caniotomy hematoma removal group with nonoperative treatment group had significant difference(p<0.05), the remained group compared with each other had not significant difference(p>0.05). On the 3th d, caniotomy hematoma removal group with brain ventricle puncture group, brain ventricle puncture group wth nonoperative treatment group had significant differenc(p<0.05), the remained group compared with each other had not significant difference(p>0.05). On the 4th day, All groups compared with each other had not significant differenc(p>0.05) except brain ventricle puncture group wth nonoperative treatment group (p<0.05). On the 7th d, 14th d, 21th d, each group with the control group had significant difference(p<0.05). All groups compared with each other had no significant(p>0.05). Each treatment group compared with each other at different time had significant difference(p<0.05) except the 3st d amd the 4th d (p>0.05). DDI in all patients adopted the half-quantitation (positive≥1.0ug/ml, negative<1.0ug/ml) on the 1st d. Adopted R×C tableχ2 test. The DDI positive rate is higher in the lower GCS scores and more brain bleeding volumes(p<0.01). The DDI positive rate is higher in Hematoma or breaking into the ventricle than those not breaking into(p<0.01). The GOS scores in discharged or death were lower, the DDI positive rate is higher(p<0.01).Conclusion: Plasma's d-dimer levels of the patients of HICH have significant correlation with the selection of treatment. The positive rate of Plasma's d-dimer admission with sereve conditions and bad prognosis had significant difference. |
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