凝血指标对急性闭合性颅脑损伤的预后判断  

Prediction of the outcome of acute closed head injury by coagulation index

作　　者：王敢[1] 胡锦[2] 高文伟[1] 田恒力[1] 戎伯英[1] 徐涛[1] 居世明[1] 

机构地区：[1]上海交通大学附属第六人民医院神经外科,上海200233 [2]复旦大学附属华山医院神经外科,上海200040

出　　处：《中华神经外科疾病研究杂志》2005年第3期204-207,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：国家自然科学基金资助项目(30371454)

摘　　要：目的评估凝血指标对各种急性单纯闭合颅脑损伤患者预后评价的意义。方法检测140例于伤后24h内到院的急性闭合颅脑损伤患者的格拉斯哥昏迷评分(GCS)、凝血酶原时间(PT)、激活部分凝血酶原时间(APTT)、纤维蛋白原含量(FIB)、D二聚体浓度(Ddimer)、血小板计数(PC)、弥漫性血管内凝血评分(DICscore),运用非参数检验及直线回归分析判断对格拉斯哥预后评分(GOS)的影响。结果GCS对急性硬膜外血肿(EDH)、急性硬膜下血肿(SDH)、急性脑挫伤的预后判断均有影响(P<0.001)。FIB含量、DIC评分只对急性硬膜下血肿组预后判断有影响(P<0.001),本组D二聚体≥5mg/L死亡率100%。结论凝血指标对急性硬膜下血肿患者预后判断有重要意义。DIC评分越高,预后越差。纤维蛋白原含量越高,预后越差。可作为颅脑损伤判断预后的指标。Objective To observe the significance of evaluation of prognosis in various types of isolated closed head injuries by coagulation and fibrinolytic index.Methods One hundred and forty isolated head injury patients were involved in this study. Admission Glascow coma scale (GCS), prothrombin time (PT), activated partial thromboplastin time (APTT), content of fibrinogen (FIB), D-dimer, platelet count (PC), as well as disseminated intravascular coagulation score (DIC score) of patients were tested within 24 h post-injury. Nonparametric tests and linear regression were used to analyze the prediction of the influence on the prognosis of the patients by Glascow outcome scale (GOS).Results Admission GCS had an impact on predicting the GOS in acute epidural hematoma (EDH), acute subdural hematoma (SDH) and acute brain contusion (BC) patients ( P <0.001). Fibrinogen content, DIC score had an impact on predicting the GOS of acute subdural hematoma patients only ( P <0.001). When D-dimer was higher than or equal to 5mg/L, all acute subdural hematoma patients died.Conclusion Coagulation and fibrinolytic index have the most obvious significance on predicting the outcome of acute subdural patients. The higher DIC score and fibrinogen content are, the lower GOS presents.

关 键 词：颅脑损伤 凝血 纤溶 D-二聚体 弥漫性血管内凝血 

分 类 号：R651.1[医药卫生—外科学]