亚低温对重型创伤性脑损伤患者凝血功能的影响  

Changes of coagulation in response to moderate hypothermia in patients with severe traumatic brain injury

作　　者：杨细平[1,2] 涂悦[2] 马铁柱[2] 彭定伟[2] 陈翀[2] 张赛[2] 

机构地区：[1]天津医科大学研究生院,300070 [2]武警后勤学院附属医院脑科医院 武警部队脑创伤与神经疾病研究所

出　　处：《中华创伤杂志》2014年第6期491-494,共4页Chinese Journal of Trauma

基　　金：国家自然科学基金资助项目（31200809）;武警后勤学院科研创新团队基金资助项目（WHTD201306）

摘　　要：目的研究亚低温对重型创伤性脑损伤（severe traumatic braininjury，sTBI）患者凝血功能的影响，探讨血栓弹力图（thmmbelastogram，TEG）监测的临床意义。方法采用随机数学表法将75例sTBI患者分为亚低温组（37例）和对照组（38例）。亚低温组于伤后24h内接受亚低温治疗。亚低温组及对照组均按照sTBI诊疗规范接受常规治疗。分别测量两组患者不同时相点凝血反应时间（clotreactiontime，R）、凝血形成时间（clotformationtime，K）、凝血形成速率（clot—ringrate，α）、血凝块最大强度（maximal amplitude，MA）及MA值后30min血凝块溶解分数（percent fibrinolysis at 30minutes after MA，LY30）值，同时监测两组患者颅内压以及生命体征、血气及血电解质等，并根据格拉斯哥预后评分（Glasgowoutcomescale，GOS）判断预后。结果两组患者在入院时R、K、α、MA及LY30值差异均无统计学意义（P〉0．05），亚低温治疗后1，2，3，7d，两组患者凝血指标差异均有统计学意义（P〈0．05）。与对照组比较，亚低温组颅内压明显降低（P〈0．01），无严重并发症，死亡率低，预后改善明显。结论亚低温治疗能改善sTBI后高凝状态，不会增加sTBI患者出现纤溶亢进的风险，并且能有效降低颅内压，具有肯定的脑保护作用。Objective To determine the effect of moderate hypothermia on coagulation in patients with severe traumatic brain injury （sTBI） and investigate the clinical significance of thrombelastogram （TEG） monitoring. Methods Seventy-five patients with sTBI were randomly assigned to hypothermia group （conventional treatment ＋ moderate hypothermia within 24 hours posttrauma, n = 38 ） and control group （ conventional treatment alone, n = 38）. TEG aided in monitoring coagulation function by measuring clot reaction time （R）, clot formation time （K）, clotting rate （α）, maximal amplitude （MA） , and percent fibrinolysis at 30 minutes after MA （LY30）. Meantime, the intracranial pressure, vital signs, blood gas values, and blood electrolytes were also measured. Outcome was evaluated by using Glasgow outcome scale （GOS）. Results The two groups were similar on admission with respect to R, K, α, MA, and LY30 （ P 〉 0.05 ）, but the coagulation index in hypothermia group was significantly different from that in control group at days 1, 2, 3 and 7 posttreatment （ P 〈 0.05 ）. Moreover, moderate hypothermia therapy demonstrated decrease of intracranial pressure （ P 〈 0.01 ） , with no severe complications, low mortality and improved outcome in comparison with control group. Conclusion Moderate hypothermia improves the hypercoagulability in patients with sTBI without increasing the risk of hyperfibrinolysis and protects brain tissue by decreasing intracranial pressure.

关 键 词：颅脑损伤 血栓弹力描记术 亚低温 

分 类 号：R651.15[医药卫生—外科学]