不同时机应用氨甲环酸对急诊颅脑创伤患者凝血功能和预后的影响  

Effects of different application timing of tranexamic acid on coagulation function and prognosis of patients with emergency traumatic brain injury

作　　者：毕宗福 常子强 Bi Zong-fu;Chang Zi-qiang(Department of Emergency,Shunyi District Hospital,Beijing 101300,China)

机构地区：[1]北京市顺义区医院急诊科,北京101300

出　　处：《中国药物应用与监测》2024年第6期721-724,共4页Chinese Journal of Drug Application and Monitoring

摘　　要：目的探讨不同时机应用氨甲环酸对急诊颅脑创伤患者凝血功能和预后的影响。方法纳入2019年1月至2022年12月北京市顺义区医院急诊科收治的颅脑创伤患者80例,按照给药时机的不同分为≤1 h注射组(50例,受伤1 h内注射氨甲环酸),1~3 h注射组(30例,受伤1~3 h注射氨甲环酸),对比两组治疗前后临床相关指标、凝血功能指标,评估两组预后效果,统计两组并发症发生率。结果≤1 h注射组血肿量(20.15±3.16)mL少于1~3 h注射组(25.17±3.84)mL,止血时间、重症监护病房(ICU)入住时间[分别为(48.15±6.18)min、(3.18±1.08)d]均短于1~3 h注射组[分别为(83.23±7.31)min、(5.37±1.14)d],差异均有统计学意义(t=6.340、22.936、8.600,均P<0.05);治疗后,两组患者凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)均较治疗前降低,且≤1 h注射组PT、APTT、FIB[分别为(10.37±1.18)s、(31.07±2.16)s、(3.05±0.31)g·L^(-1)]低于1~3 h注射组[(11.16±1.14)s、(34.36±2.48)s、(3.53±0.58)g·L^(-1)],差异均有统计学意义(t=2.936、6.237、4.827,均P<0.05);治疗1个月后,≤1 h注射组格拉斯哥预后量表(GOS)评分5分患者多于1~3 h注射组,1~3 h注射组GOS评分1分患者多于≤1 h注射组,差异均有统计学意义(χ2=4.832、10.811,均P<0.05);≤1 h注射组并发症发生率12.00%(6/50)低于1~3 h注射组40.00%(12/30),差异有统计学意义(χ^(2)=8.430,P<0.05)。结论受伤1 h内对急诊颅脑创伤患者注射氨甲环酸能有效改善其凝血功能,缓解出血状况,降低并发症发生率,促进预后恢复。Objective To investigate the effects of different application timing of tranexamic acid on coagulation function and prognosis of patients with emergency traumatic brain injury.Methods According to different timing of administration,80 patients with traumatic brain injury admitted to Shunyi District Hospital from January 2019 to December 2022 were enrolled and divided into the≤1 h injection group(n=50,tranexamic acid injection within 1h after injury)and the 1-3 h injection group(n=30,tranexamic acid injection within 1-3h after injury).The clinical indexes and coagulation function in the two groups were compared before and after treatment.The prognostic effect was evaluated after treatment.The incidence of complications in the two groups was statistically analyzed.Results The hematoma volume in the≤1 h injection group was less than that in the 1-3 h injection group((20.15±3.16)mL vs(25.17±3.84)mL)whereas the hemostasis time and stay time in intensive care unit(ICU)were shorter than those in the 1-3 h injection group((48.15±6.18)min vs(83.23±7.31)min,(3.18±1.08)d vs(5.37±1.14)d),the differences were statistically significant(t=6.340,22.936,8.600,all P<0.05).After treatment,prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(FIB)were decreased in both groups and they were lower in the≤1 h injection group than in the 1-3 h injection group((10.37±1.18)s vs(11.16±1.14)s,(31.07±2.16)s vs(34.36±2.48)s,(3.05±0.31)g·L^(-1)vs(3.53±0.58)g·L^(-1)),showing statistically significant differences(t=2.936,6.237,4.827,all P<0.05).After 1 month of treatment,proportion of Glasgow outcome scale(GOS)score of 5 points was higher but proportion of GOS score of 1 points lower in the≤1 h injection group than in the 1-3 h injection group,the differences were statistically significant(χ2=4.832,10.811,both P<0.05).The incidence of complications in the≤1 h injection group was lower than that in the 1-3 h injection group and the difference was statistically significant(12.00%(6/50)vs 40.00%(12/

关 键 词：颅脑创伤 氨甲环酸 纤维蛋白原 凝血酶原时间 活化部分凝血活酶时间 预后 

分 类 号：R651.15[医药卫生—外科学]