大脑额叶损伤患者D-二聚体异常对预后的影响  

Effect of D-dimer abnormality on the prognosis of patients with frontal lobe injury

作　　者：过梅 张玮艳 李玮珏 程宝莉[2] 伍棵杨 方向明[2] Guo Mei;Zhang Weiyan;Li Weijue;Cheng Baoli;Wu Keyang;Fang Xiangming(Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Anesthesiology,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院,杭州310003 [2]浙江大学医学院附属第一医院麻醉科,杭州310003

出　　处：《中华急诊医学杂志》2021年第12期1434-1437,共4页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金(81971876)。

摘　　要：目的探讨大脑额叶损伤患者D-二聚体水平异常对预后的影响,为额叶损伤患者的临床诊疗及预后评估提供新的思路。方法回顾性分析2020年11月1日至2021年2月1日收治于浙江大学医学院附属第一医院外科监护室的脑外伤患者71例,按照脑外伤是否累及额叶分为实验组(44例)和对照组(27例)。记录两组患者性别、年龄、BMI、住院时间、ISS创伤评分、GCS昏迷评分、qSOFA评分、GOS预后评分及入院24 h内凝血指标检测结果等临床资料,统计分析比较两组间各项指标的差异。结果①与对照组相比,大脑额叶损伤的患者D-二聚体水平显著增高(P<0.01);②大脑额叶损伤的患者并发症的发生率为40.9%,其中下肢静脉血栓的发生率为18.2%,对照组患者并发症发生率为18.5%,其中下肢静脉血栓的发生率为3.7%,两者均差异有统计学意义(P<0.05);③对照组患者的平均住院时间为10.96 d,实验组患者的平均住院时间为15.50 d,两组患者住院时间差异有统计学意义(P<0.05);④大脑额叶损伤的患者28 d病死率为18.2%,对照组患者28 d病死率为7.4%,两组病例28 d病死率差异无统计学意义(P>0.05);⑤大脑额叶损伤的患者D-二聚体的水平与GOS预后评分具有显著相关性(P<0.01),两者负性相关(r=-0.501)。结论大脑额叶损伤的患者D-二聚体水平升高,并发症的发生率增加,住院时间延长;大脑额叶损伤患者的D-二聚体水平与预后具有显著的负相关性,D-二聚体可以作为评估额叶损伤患者预后的一个敏感指标,D-二聚体水平越高,患者预后越差。Objective To investigate the effect of abnormal D-dimer level on the prognosis of patients with frontal lobe injury,and to provide a new idea for clinical diagnosis,treatment and prognosis evaluation of frontal lobe injury.Methods A retrospective analysis was performed on 71 patients with traumatic brain injury(TBI)who were admitted to the Surgical Care Unit of the First Affiliated Hospital of Zhejiang University School of Medicine from November 1,2020 to February 1,2021.According to whether TBI involved in the frontal lobe,the patients were divided into the experimental group(n=44)and the control group(n=27).Clinical data including sex,age,body mass index(BMI),length of hospital stay,ISS trauma score,GCS coma score,qSOFA score,GOS prognostic score and coagulation index test results within 24 h of admission of the two groups were recorded,and the difference of each index between the two groups was compared.Results①D-dimer levels were significantly higher in the experimental group than in the control group(P<0.01);②The incidence of complications in the experimental group was 40.9%,of which the incidence of lower limb vein thrombosis was 18.2%,and the incidence of complications in the control group was 18.5%,of which the incidence of lower limb vein thrombosis was 3.7%;there were statistical differences between the two groups(P<0.05);③The average hospital stay of patients was 10.96 days in the control group,and 15.50 days in the experimental group with a statistically significant difference between the two groups(P<0.05);④The 28-day mortality rate of patients in the experimental group was 18.2%and 7.4%in the control group.There was no significant difference in 28-day mortality between the two groups(P>0.05);⑤The level of D-dimer was negatively correlated with GOS prognostic score in patients with frontal lobe injury(r=-0.501,P<0.01).Conclusions Patients with frontal lobe injury have increased D-dimer levels,increased incidence of complications,and longer hospital stay.There is a significant negative corre

关 键 词：脑外伤 额叶 D-二聚体 预后 

分 类 号：R651.15[医药卫生—外科学]