早期抗凝治疗对创伤性脑损伤患者静脉血栓栓塞的影响  

Effect of early anticoagulant therapy on venous thromboembolism in patients with traumatic brain injury

作　　者：赵建伍 王兆斌[1] 薛勇[1] 赵学俊[1] ZHAO Jian-wu;WANG Zhao-bin;XUE Yong;ZHAO Xue-jun(Department of Neurosurgery,Puyang Oilfield General Hospital,Puyang,Henan 457000,China)

机构地区：[1]濮阳市油田总医院神经外科,河南濮阳457000

出　　处：《医药论坛杂志》2023年第19期83-86,90,共5页Journal of Medical Forum

摘　　要：目的探讨早期抗凝治疗(anticoagulant therapy,ACT)对创伤性脑损伤(traumatic brain injury,TBI)患者静脉血栓栓塞的影响。方法选取2020年1月-2022年6月濮阳市油田总医院住院治疗的TBI患者173例,应用回顾性研究方法,根据患者入院后病情进展将其分为病情无恶化组和病情恶化组。对比分析两组患者的一般资料和临床结局,应用Logisitic回归分析探讨早期抗凝治疗对创伤性脑损伤患者静脉血栓栓塞的相关影响因素。结果病情恶化组患者入院后开始ACT时间5(3,11)d显著低于病情无恶化组患者10(3,15)d。急性肾衰竭是TBI患者病情恶化的危险因素(P<0.05,OR>1);受伤后至ACT时间长、入院时GCS评分高是TBI患者病情恶化的保护因素(P<0.05,OR<1)。结论早期ACT与TBI患者病情进展的高风险相关,因此在开始ACT之前,应仔细评估每个病例中出血和血栓栓塞风险之间的平衡。Objective To investigate the effect of ACT on the venous thromboembolism of TBI.Methods Totally 173 TBI patients admitted to Puyang Oilfield General Hospital from January 2020 to June 2022 were selected.Retrospective study was used.According to the progress of patients'condition after admission,they were divided into no deterioration group and deterioration group.The general data and clinical outcomes of the two groups were compared and analyzed.To investigate the influencing factors of early anticoagulant therapy on venous thromboembolism in patients with traumatic brain injury by Logisitic regression analysis.Results The start time of ACT in the deterioration group was 5(3,11)days after admission,which was significantly lower than that of the non deterioration group by 10(3,15)days.Acute renal failure was a risk factor for the deterioration of TBI patients(P<0.05,OR>1);The long time from injury to ACT and the high GCS score at admission were the protective factors for the deterioration of TBI patients(P<0.05,OR<1).Conclusion Early ACT is associated with a high risk of disease progression in patients with TBI.Therefore,be⁃fore starting ACT,the balance between bleeding and thromboembolism risk in each case should be carefully evaluated.

关 键 词：抗凝 创伤性脑损伤 静脉血栓栓塞 病情 进展 

分 类 号：R651.15[医药卫生—外科学]