凝血异常对急性颅脑损伤预后意义的研究  

The Prognostic Implication of Hemostatic Disorders with Head injury

作　　者：王健[1] 王安生[2] 周春兰[1] 李迎山[2] 胡凯[1] 

机构地区：[1]西安市中心医院血液病研究所,陕西西安710003 [2]西安市中心医院神经外科,陕西西安710003

出　　处：《现代检验医学杂志》2004年第2期28-30,共3页Journal of Modern Laboratory Medicine

摘　　要：目的 研究凝血异常对评估急性颅脑损伤伤情及预后的价值。方法 以PT、TT、KPTT、PC、Fg、D-二聚体、PLM活性、PAI等8项指标,对75例急性颅脑损伤患者于伤后24 h内、1 w、2 w时进行检测,与正常对照组比较;再按伤情轻重、损伤类型及转归等进行组间比较。结果 ①凝血异常,伤后24 h内为90.67％,DIC为10.6％,伤后2 w为68.97％。②伤后24 h内凝血异常为7项(P<0.001);1,2 w D-dimer显著异常(P<0.001)。③凝血异常在脑内血肿组,GCS≤8分组及死亡组均较对照组显著。早期6-7项异常,以D-dimer PLM及PAI最为显著(P<0.01);1,2 w此3项仍显著(P<0.01)。④24 h内凝血异常>3项,且以D-dimer、PLM、PAI为主,则迟发脑内出血发生率高。⑤早期D-dimer水平>8 mg/L,死亡率高(63.13％)。结论 凝血异常,在急性颅脑损伤中表现明显高达90.67％。早期血液高凝与继发纤溶亢进并存,后期以纤溶亢进为主。早期凝血异常指标>3项,且以纤溶指标为主时,伤情严重,迟发脑出血发生率高,死亡率高。提示凝血异常对评估脑外伤预后极有价值。Objective To evaluate the predictive value of hemostatic disorder (HD) on the severity and outcome in head injured patients. Methods PT,TT,KPTT,PC,Fg.D-dimer,PLM and PAI were measured in 75 head injured patients within 24h and after 1-2 weeks. The HD was also compared in following groups;brain hematoma vs non-hematoma,GCS≤8 vs GCS>8,delate brain hemorrhage vs non-hemorrhage,died vs alive. Results (1) The frequency of HD was 90. 67% in 24h and DIC was 10. 67%. (2) The items of HD were 7 in early stage,but the D-dimer lasted 2 weeks and changed significantly (P<0. 01). (3) The HD was more prominent in sever injured groups,especially the D-dimer,PLM and PAI(P<0. 01). (4) The items were more than 3(mainly it was the fibrinolytic parameters) in delate brain hemorrhage group(P<0. 01). (5) The level of D-dimer was>mg/L in early stage. The death rate was as high as 63. 13%. Conclusion The frequency of HD was very high in acute head injury. The hypercoagulation and secondary hyperfibrinolysis coexisted in early stage. Later the fibrinolysis was prominent. The items of HD were<3,especially it was the parameters for fibrolysis.it indicated the trauma was sever,and the chance of delate brain hemorrhage and death was high. This suggests that the HD is valuable prognostic markers in the acute head injury.

关 键 词：凝血异常 D-二聚体 纤溶酶 纤溶酶原激活剂抑制物 颅脑外伤 急性颅脑损伤 预后 

分 类 号：R446.112[医药卫生—诊断学] R651.15[医药卫生—临床医学]