颅脑外伤患者使用氨甲环酸时间窗的研究  

Study on time window of tranexamic acid use in patients with traumatic brain injury

作　　者：熊海兵[1] 徐睿[2] 程强[1] 朱继[2] 

机构地区：[1]重庆市巴南区人民医院神经外科,401320 [2]重庆医科大学附属第一医院神经外科,400016

出　　处：《检验医学与临床》2017年第19期2821-2823,共3页Laboratory Medicine and Clinic

基　　金：国家临床重点专科建设项目[(2011)170号];重庆市卫生和计划生育委员会2015年重庆市临床重点专科建设项目[渝卫医发[2015]517号]

摘　　要：目的比较分析早期和晚期使用氨甲环酸对患者预后的影响;提出氨甲环酸的最佳治疗时间窗。方法选取2015-2016年经CT证实有颅脑外伤的患者112例,以时间窗为标准,分为早期治疗组53例及晚期治疗组59例,3h之内使用氨甲环酸的患者列入早期治疗组,3h之后使用的患者列入晚期治疗组。治疗后24h后复查凝血象及血小板,比较两组弥散性血管内凝血(DIC)评分。入院后24~48h至少复查1次头颅CT,追踪患者3个月后的预后,比较两组患者进展性颅内出血的发病率及预后。结果早期治疗组患者DIC评分有明显改善,早期治疗组进展性颅内出血的发病率更低,早期治疗组的预后更好,差异均有统计学意义(P<0.05)。结论早期使用氨甲环酸能更有效地治疗外伤性凝血功能障碍,减少进展性颅内出血,从而改善患者预后。Objective To comparatively analyze the influence of early and late use of tranexamic acid on the prognosis of the patients with traumatic brain injury and to propose its best treatment time window.Methods One hundred and twelve patients with craniocerebral injury confirmed by CT in the hospital from 2015 to 2016were selected and divided into the early treatment group（53cases）and late treatment group（59cases）according to the time window as the criteria.The patients with tranexamic acid use within 3hwere included in the early treatment group and which after 3hwere included in the late treatment group.The coagulogram and platelet were reexamined after 14 htreatment.Then the disseminated intravascular coagulation（DIC）scores were compared between the two groups.The skull CT was reexamined at least once.The prognosis after 3 months was tracked.The occurrence rate of progressive intracranial hemorrhage and prognosis after 3 months were compared between the two groups.Results The DIC score after treatment in the early treatment group was significantly improved;the early treatment group had lower occurrence rate of progressive hemorrhage and better prognosis,differences were statistically significant（P〈0.05）.Conclusion Early use of tranexamic acid can more effectively treat the traumatic coagulation function disorder,reduces the progressive intracranial hemorrhage,thus improves the patient＇s prognosis.

关 键 词：氨甲环酸 颅脑外伤 凝血功能 进展性颅内出血 预后 

分 类 号：R651.45[医药卫生—外科学]