急性颅脑损伤病人凝血功能的改变及临床意义  

Changes of coagulation functions in the patients with acute head injury

作　　者：丁欢[1] 马玉杰[1] 陈建红[1] 马希刚[1] 曹相原[1] 杨晓军[1] 

机构地区：[1]宁夏医学院附属医院,宁夏银川750004

出　　处：《宁夏医学杂志》2008年第7期588-590,共3页Ningxia Medical Journal

摘　　要：目的研究急性颅脑损伤病人凝血功能异常对病情严重程度和预后的判断价值。方法测定64例急性颅脑损伤病人入住ICU6小时内的血浆凝血酶原时间(PT)、活化部分凝血激酶时间(APTT)、D-二聚体(D-dimer)及血小板。分析比较各研究分组间上述凝血指标异常与病情严重程度及预后的关系。结果PT、APTT及D-dimer异常在各型急性颅脑损伤组间差异有统计学意义(P<0.01),且与病情严重程度有显著相关性(P<0.01)。而血小板异常与急性颅脑损伤病人病情严重程度无关。死亡组PT、APTT较生存组明显延长(P<0.01),D-dimer较生存组明显增高(P<0.01),两组间血小板比较差异无统计学意义(P>0.05);PT、APTT及D-dimer异常与急性颅脑损伤病人预后存在显著的正相关(P<0.01)。结论急性颅脑损伤病人凝血功能异常较为常见,其中PT、APTT、D-Dimer异常对病情严重程度及预后有重要的判断价值。Objective To investigate the changes of coagulation functions in the patients with acute head injury and to study the value in estimating the severity and prognosis. Methods To detect the levels of PT（ prothrombin time） ,APTT（ activated partial thromboplastin time） ,D -dimer and Platelet of patients during 6h after the patients registered the ICU. 64 cases with acute head injury in the intensive care unit（ICU） were divided into four groups according to the Glasgow coma score（GCS） ;To divide 64 patients into the survival group and death group according to the outcome. GCS were determined at the admission day. The relationship between the coagulation markers and severity and outcome were studied. Results The levels of PT,APTT and D - dimer were markedly difference among groups with different GCS groups （ P 〈 0. 01 ）, and they were correlated well with the severity of illness （ P 〈 0. 01 ）. The levels of PT and APTT were obviously prolonged in death group than those of survival group（ P 〈 0.01 ）, and the level of D - dimer was dramatically higher in death group （ P 〈 0. 01 ）. The changes of PT, APTT and D - dimer were correlated well with the prognosis of illness too （ P 〈 0. 01 ）. However, there were no significant difference between the level of Platelet and the severity and outcome of illness （ P 〉 0. 05 ）. Conclusion There are the dysfunctions of coagulation in the patients with acute head injury. The changes of PT,APTT and D -dimer can be used to evaluate the severity and prognosis of acute head injury.

关 键 词：急性颅脑损伤 凝血功能 格拉斯哥昏迷评分 预后 

分 类 号：R651.15[医药卫生—外科学]