闭合性颅脑损伤患者凝血功能变化与预后的关系  

Relationship between change of coagulation function and prognosis in patients with traumatic brain injury

作　　者：王大芬[1] 王强[1] 周定耕[2] 

机构地区：[1]四川省什邡市人民医院,四川什邡618400 [2]南华大学附属第二医院急诊科,湖南衡阳421001

出　　处：《海南医学院学报》2015年第3期387-389,共3页Journal of Hainan Medical University

基　　金：湖南省自然科学基金衡阳联合基金(13JJ9009)~~

摘　　要：目的:探讨闭合性颅脑损伤(TBI)患者早期凝血功能变化与预后的关系。方法:选取我院2012年1月~2013年1月收治的单纯TBI患者96例,以Glasgow昏迷评分(GCS)为依据分为轻度组、中度组、重度组,测定各组患者创伤后4、12、24、72h凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、部分凝血活酶时间(PTT)、纤维蛋白降解产物(FDP)及D一二聚体(DD)水平变化;并于创伤后1个月采用牛津残障评分(OHS)评估各组患者预后,观察不同预后患者凝血功能指标及两者间的相关性;设立同期来院体检正常者为对照组进行对照分析。结果:中、重度组患者创伤后各时间点PT、APTT均较轻度组及对照组显著延长(P<0.05);轻、中、重度组PTT较对照组显著延长(P<0.05),中、重度组PTT延长时间显著高于轻度组(P<0.05);轻、中、重度组创伤后各时间点FDP值、D-dimer水平显著高于对照组(P<0.05);创伤6个月后,死亡及预后不良组创伤4h时患者PT、APTT、PTT、FDP、DD显著高于预后良好组(P<0.05)。结论:TBI患者创伤后即可产生凝血功能障碍,血浆PT、FDP、DD水平变化与颅脑损伤程度呈正相关,早期检测凝血纤溶指标对判断TBI预后具有一定临床价值。Objective; To explore the relationship between the change of early coagulation function and the prognosis in the patients with traumatic brain injury （TBI）. Methods： A total of 96 merely TBI patients who were admitted in our hospital from January, 2012 to January, 2013 were included in our study. The patients were divided into the mild group, the moderate group, and the severe group according to the Glasgow Coma Scale （GCS）. The PT, APTT, PTT, FDP, and the levels of DD in the patients of all groups 4, 12, 24, 72h after trauma were measured. One month after trauma, Oxford Handicap Scale （OHS） was used to estimate the prognosis, and observe the coagulation functional parameters of the patients with different prognosis and the relationship between them. The healthy individuals who came to our hospital for physical examination were served as the control. Results： The PT and APTT in each timing point after trauma in the moderate and severe patients were significantly prolonged when compared with those in the mild and the control group （P〈0.05）. PTT in the mild, moderate, and severe groups were significantly extended when compare with that in the control group （P〈0.05）. The extension time of PTT in the moderate and severe groups was significantly higher than that in the control group （P^0.05）. The FDP value and D-dimer in each timing point after trauma in the mild, moderate, and severe groups were significantly higher than those in the control group （P〈0.05）. Six months after trauma, PT, APTT, PTT, FDP, and DD in the patients 4h after trauma whose death and prognosis were unfavorable were significantly higher than those in the patients with a favorable prognosis （P〈0.05）. Conclusions： Coagulation disorders can occur in the TBI patients after trauma, and the changes of serum PT, FDP, and DD are positively correlated with the degree of brain injury; therefore, early detection of coagulation fibrinolysis indicator has a certain clinical value in predicating TBI prognosis.

关 键 词：闭合性颅脑损伤(TBI) 疑血功能 预后 关系 

分 类 号：R651.15[医药卫生—外科学]