目的 探討顱腦損傷急性期血小板（PLT）參數與外傷性腦梗死（TCI）的關系。 方法 選取2010年9月－2012年1月符合納入除標準的顱腦損傷患者191例。將傷后14 d內發生腦梗死的患者劃入觀察組，余為對照組。分別于傷后第24、48小時，第3、7、14天，采集肘靜脈血對PLT計數、PLT平均體積（MPV）、PLT體積分布寬度（PDW）；傷后24 h行格拉斯哥昏迷評分（GCS），傷后6個月隨訪行格拉斯哥結果評分（GOS）。分別分析腦梗死與上述PLT參數的關系、PLT參數與顱腦損傷病情輕重的關系以及與預后的關系。 結果 觀察組PLT計數降低、MPV升高、PDW升高；觀察組患者GCS/GOS與PLT計數呈正相關，與MPV、PDW呈負相關。 結論 PLT計數、MPV、PDW均與TCI有關，三者中PLT最具臨床意義。PLT計數越低、MPV和PDW越高，腦梗死可能性越大，顱腦損傷可能越嚴重，預后可能越差。
【摘要】 目的 探討中型和重型顱腦損傷后患者血小板（platelet，Plt）參數的變化特點及臨床意義。 方法 選取2009年3月-2010年3月腦外傷后24 h內入院的顱腦損傷患者75例作為觀察組，于傷后1、3、7、14 d采血測定Plt數量、血小板平均體積（mean platelet volume，MPV）、血小板體積分布寬度（platelet distribution width，PDW），并同時進行格拉斯哥昏迷評分（Glasgow coma scale，GCS）。同時選取60例健康體檢者，測定Plt、MPV和PDW作為對照組。 結果 觀察組傷后1、3、7 d Plt計數分別為（106.21±36.31）、（102.76±35.23）、（108.37±31.32）×109/L，較對照組[（210.41±68.56）×109/L]明顯降低（Plt;0.05）；觀察組傷后1、3、7 d MPV分別為（12.34±1.34）、（11.21±1.52）、（10.78±1.36） fL，PDW分別為（15.78±1.26）、（17.67±1.16）、（16.72±1.21） fL，均較對照組[MPV：（8.24±1.76） fL，PDW：（12.86±1.42） fL]明顯升高（Plt;0.05）；傷后14 d Plt、MPV和PDW均較對照組差異無統計學意義（Pgt;0.05）。GCS≤8分組傷后1 d Plt計數為（96.85±36.52）×109/L，明顯低于GCSgt;8分組[（123.85±35.78）×109/L]，而GCS≤8分組MPV為（12.14±1.32） fL，PDW為（18.63±1.21） fL，均明顯高于GCSgt;8分組[MPV：（9.78±1.34） fL，PDW：（16.72±1.34） fL]，差異均有統計學意義（Plt;0.05）。傷后第1天Plt與隨訪6個月GOS評分呈正相關（r=0.625，Plt;0.05）。 結論 中型和重型顱腦損傷后Plt計數明顯降低，MPV和PDW值明顯升高，且與傷情及預后有關。Plt及其參數的檢測有助于對傷情、預后的判斷。【Abstract】 Objective To investigate the platelet parameters changes and its clinical significance in medium and severe head injury patients. Methods From March 2009 to March 2010, 75 brain injury patients hospitalized within 24 h after injury were included in this study. The platelet number (Plt), mean platelet volume (MPV), platelet volume distribution width (PDW) and Glasgow coma scale were measured on the first, third, seventh and fourteenth day after injury respectively. We also measured the Plt, MPV and PDW of 60 healthy volunteers to make comparisons. Results The Plt counts were (106.21±36.31), (102.76±35.23), and (108.37±31.32)×109/L in the head injury patients on the first, third, and 7th day respectively, which were significantly lower than those in the control group [(210.41±68.56)×109/L] (Plt;0.05); the MPV and PDW values measured on the first day [MPV: (12.34±1.34) fL, PDW: (15.78±1.26) fL] and the third day [MPV: (11.21±1.52) fL, PDW: (17.67±1.16)fL] were both significantly lower than those of the control group (Plt;0.05); There was no evidence of a difference in Plt, MPV and PDW between the two groups fourteen day after injury (P＞0.05); The Plt count was (96.85±36.52)×109/L in GCS≤8 group on the first day, which was significantly lower than that of GCSgt;8 group [(123.85±35.78) fL, Plt;0.05]; However, the MPV and PDW values in GCS≤8 group [(MPV: (12.14±1.32) fL, PDW: (18.63±1.21) fL] were both significantly higher than those of GCSgt;8 group [MPV: (9.78±1.34) fL, PDW: (16.72±1.34) fL, Plt;0.05]; The Plt count was correlated with GOS score positively (r=0.625,Plt;0.05). Conclusions Medium and severe head injury patients are significantly associated with a lower Plt count and increased MPV and PDW values. The Plt parameters changes are correlated with the prognosis of patients. Therefore, the measurement of Plt parameters may contribute to the valuation of severity and prognosis, and provide new ideas for treatment of head injury patients.