重型颅脑损伤患者凝血纤溶动态变化及临床意义

Dynamic changes and clinic significance of coagulation and fibrolysis in patients with severe traumatic brain injury

目的:探讨重型颅脑损伤患者凝血纤溶变化规律及其临床意义。方法:对本院2005年10月至2006年12月收治的33例重型颅脑损伤患者(GCS≤8分及APACHEⅡ≥10分)进行前瞻性研究,测定其入院第1、3、7天血管内皮素(ET)、血小板颗粒蛋白-140(GMP-140)、D-二聚体(D-dimer,D-D)及入院第1、3天部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血时间(TT);取同期健康人群20例作对照组。结果:ET、GMP-140、D-D在入院第1天明显升高,之后呈下降趋势,第3天仍高于正常,与对照组比较差异有显著性(P<0.05),第7天GMP-140接近正常,与对照组比较差异无显著性(P>0.05),而ET及D-D仍高于对照组(P<0.05)。APTT、PT、TT在入院第1天明显延长,APTT、TT3d后虽有所缩短,但与对照组比较差异仍有显著性(P<0.05),PT在入院第3天恢复正常。ET、GMP-140、D-D水平与GCS评分呈负相关(P<0.05),APTT、PT、TT与GCS评分无相关性(P>0.05)。结论:重型颅脑损伤早期即可发生凝血纤溶异常,其异常程度与颅脑损伤程度有相关性。

Objective To investigate dynamic changes and clinical significance of coagulation and fibrolysis in patients with severe traumatic brain injury. Methods Thirty three consecutive patients （Glasgow coma scale ≤ 8 and APACHE Ⅱ≥ 10） with severe traumatic brain injury were included in the perspective study. The endothelin（ET）, alphagranular membrane protein-140（GMP-140）, D-dimer levels and active partial thromboplstin time （APTT）, prothrombin time（PT） and thrombin time（qT） were measured in these patients. The statistic significance was accepted at P 〈 0.05. Results The ET, GMP-140, D-dimer levels increased markedly at the time of admission and decreased gradually latterly. ET and D-dimer levels were significantly higher than that in control group even after 7 days. APTT, PT and TT were significantly prolonged at the time of admission,and were kept for 3 days in all but PT group. There was closely negative relationship between GCS and ET, GMP-140 or D-dimer levels, and no relationship between GCS and AP＇IT, PT, or TT in these groups. Conclusions Coagulation and fibrinolytic abnormalities can be occurred in very early stage of patients with severe traumatic brain injury. The extent of coagulation and fibrinolytic markers may be related to severe traumatic brain injury.