单纯严重脑外伤患者组织低灌注发生率与凝血功能紊乱关系的临床研究  

Relationship between hypoperfusion and early coagulopathy after isolated severe traumatic brain injury

作　　者：杨田军[1] 戴金龙 何卫华[3] 刘宝[1] 

机构地区：[1]安徽省立医院ICU,安徽合肥230001 [2]六安市中心医院,安徽六安237100 [3]怀宁县人民医院,安徽安庆246121

出　　处：《中国急救医学》2012年第9期838-841,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的研究单纯严重脑外伤患者入院时组织低灌注的发生率，并探讨组织低灌注与单纯严重脑外伤患者凝血功能紊乱的关系。方法回顾性分析2004—01—2011—03入住安徽省立医院重症病房119例单纯脑外伤患者入院时凝血指标、生存率、血乳酸等。根据乳酸水平计算入院时患者发生组织低灌注的比例，同时行Logistic回归明确组织低灌注是否为发生凝血功能紊乱的危险因素。ROC曲线评价乳酸预测发生凝血功能紊乱的价值。结果以乳酸水平〉2mmol／L为组织低灌注诊断标准，78例患者入院时血乳酸高于该值，发生率为65．5％，其中44例发生凝血功能紊乱（56．4％）；而41例入院时血乳酸〈2mmol／L，只有14例发生凝血功能紊乱（34．1％）。乳酸水平〉2．85mmol／L预测发生凝血功能紊乱的敏感性为67．2％，特异性为88．5％（AUC=0．806±0．042，95％C10．723—0．889，最大约登指数0．558，P〈0．0001）。58例患者入院时即有凝血功能紊乱，其中死亡组32例（64．0％），存活组26例（37．7％），组间比较差异有统计学意义（P=0．005）；凝血功能紊乱组乳酸水平明显高于正常组（P〈0．001）。结论单纯严重脑外伤患者发生组织低灌注的比例非常高，而且低灌注是这类患者发生凝血功能紊乱的独立危险因素。发生凝血功能紊乱患者的死亡率明显升高。Objective To study the incidence of tissue hypoperfusion in victims of severe traumatic brain injury （sTBI） and to determine the relationship between hypoperfusion and TBI coagulopathy. Methods Retrospective analysis was made in the patients with isolated sTBI （head AIS≥3, extracranial injuries AIS 〈 3）. TBI coagulopathy was defined as thrombocytopenia and/or elevated international normalized ratio （INR） and/or prolonged activated partial thromboplastin time （APTT）. Univariate and multivariate analysis was performed to identify the associations among hypoperfusion, coagulopathy and mortality. Results A total of 119 patients met the study criteria. 78 patients with blood lactate were higher than 2 mmol/L. The incidence rate was 65.5%. TBI - associated early coagulopathy occurred in 44 patients （ 56.4% ）. Mean lactate values were significantly higher in the patients with coagulopathy compared with their non - coagulopathie counterparts at hospital admission （3.14 ±0.98 vs 2.10 ±0.61 ,P 〈0. 001 ）. In the Logistic regression analysis, an admission lactate 〉2 mmol/L were independently associated with early coagulopathy. Coagulopathy was associated with increased mortality in the patients after severe head trauma （ P = 0. 005 ）. The optimal cutoff points of lactate level to predict the coagulopathy was 2.85 （ sensitivity 67.2% , specificity 88.5% , AUC = 0. 806 ± 0. 042, 95% CI 0. 723 - 0. 889）. Conclusion Tissue hypoperfusion has very high proportion in isolated severe traumatic brain injury patients, and is an independent risk factor for eoagulopathy, and the mortality is higher in the patients with eoagulopathy

关 键 词：单纯严重脑外伤 凝血功能紊乱 乳酸 低灌注 

分 类 号：R441.7[医药卫生—诊断学]