中至重型颅脑创伤患者多次输血影响因素分析

Analysis on the risk factors for multiple transfusion in patients with moderate or severe traumatic brain injury

目的分析中至重型颅脑创伤患者多次输血影响因素。方法 2018年1月至2019年6月行去骨瓣减压术的53例中至重型颅脑创伤患者,根据凝血功能、血小板计数和临床表现(如有无创面渗血)确定是否输血;采用单因素和多因素Logistic回归分析筛查造成反复多次输血的危险因素。结果根据输血次数分为多次输血组(11例)和对照组(未输血或仅术中单次输血,42例)。多次输血组患者凝血酶时间(P=0.041)、国际标准化比值(P=0.048)、纤维蛋白降解产物(P=0.000)和D-二聚体(P=0.001)水平均高于对照组,纤维蛋白原低于对照组(P=0.006);Logistic回归分析显示,纤维蛋白降解产物是颅脑创伤患者反复多次输血的危险因素(OR=1.013,95%CI:1.005~1.021;P=0.002)。结论血清纤维蛋白降解产物水平升高是造成中至重型颅脑创伤患者反复多次输血的主要危险因素。

Objective To analyze the risk factors for multiple transfusions in patients with moderate or severe traumatic brain injury(TBI).Methods The clinical data of 53 patients undergoing decompressive craniectomy with moderate or severe TBI from January 2018 to June 2019 were analyzed.Coagulation indexes were tested before decompressive craniectomy.The factors associated with multiple transfusions were analyzed by univariate and multivariate Logistic regression analysis.Results Patients were divided into multiple transfusion group(11 cases) and control group(42 cases,no transfusion or single transfusion).Thrombin time(P=0.041),international normalized ratio(P=0.048),fibrinogen degradation product(P=0.000) and D-dimer(P=0.001) in the multiple transfusion group were higher than those in the control group,while fibrinogen was lower than those in the control group(P=0.006).Logistic regression analysis showed that fibrinogen degradation product was a risk factor for multiple transfusions(OR=1.013,95%CI:1.005-1.021;P=0.002).Conclusions Elevated fibrinogen degradation product is a risk factor for multiple transfusions in patients with moderate or severe TBI.