血栓弹力图在重型颅脑创伤患者凝血功能障碍研究中的意义

Significance of thrombelastogram in the study on coagulation disorder of patients with severe traumatic brain injury

目的探讨血栓弹力图作为颅脑创伤患者凝血功能障碍预测指标的可行性，以及指导临床治疗的实用性。方法重型颅脑创伤患者（31例）及其他外伤患者（6例）共计37例，分别于外伤后24h、72h和7d施行血栓弹力图检测，观察反应时间（R值）、凝固时间（K值）、血栓最大幅度（Ma值）和凝固角（α值）等项参数在不同测量时间点的变化规律。结果不同处理组四项凝血功能参数比较，除R值差异无统计学意义（P=0．125），其余3项参数（K值、Ma值和d值）差异均有统计学意义（P=0．000），组内不同测量时间点比较差异亦有统计学意义（P=0．000），且二者之间存在交互作用（P=0．000）。与其他外伤组患者比较，颅脑创伤组患者R值和K值变化以伤后24h最低（均P=0．000）、72h最高（均P=0．000），至伤后7d两组之间差异无统计学意义（P=0．351，0．247）；而Ma值和α值变化以伤后24h最高（均P=0．000）、72h最低（均P=0．000），至伤后7出两组之间差异无统计学意义（P=0．445，0．563）。结论重型颅脑创伤患者与其他外伤患者凝血功能障碍存在差异性，前者更为严重，其凝血功能变化具有一定规律性，即伤后24h呈高凝状态、72h为低凝状态，至伤后7d，各项凝血功能参数恢复至正常值范围。

Objective To investigate the feasibility and practicability of thrombelastogram （TEG） in detection and direction for clinical treatment of coagulation disorder in patients with severe traumatic brain injury （sTBI）. Methods In this study, there Were 31 patients with simple sTBI （group A） and 6 patients with other traumatic injury （group B）. TEG was performed in all the patients at 24h, 72 h and 7 d after injury. The changes of reaction time （R value）, coagulation time （K value）, maximum thrombus consistency （Ma value） and coagulation angle （α value） were examined at different time points after injury. Results With the exception of R value （P= 0.125）, the K value, Ma value andα value in group A were all significantly different from those in group B （P= 0.000, for all）. In each group, the differences of all the parameters at different time points were all significant （P= 0.000, for all）. And there were interactions between the groups and different time points （P=0.000, for all）. In comparison with group B, the R value and K value in group A achieved to the lowest point at 24 h （P=0,000, for all）, and the highest at 72 h （P= 0.000, for all） after injury. There were no significant differences in the R value and K value between both groups at 7 d after injury （P= 0.351, 0.247; respectively）. The changes of the Ma value and ot value were the highest at 24 h （P= 0.000, for all）, and the lowest at 72 h （P= 0.000, for all） after injury, but no significant differences were seen between both groups at 7 d after injury （P= 0.445, 0.563; respectively）. Conclusion Coagulation disorder of patients with sTBI appears more severe than that in other traumatic injuried patients, and there are certain regularity changes in coagulation disorder. Hypercoagulability and hypocoagulability are seen at 24 h and 72 h after injury, respectively, and the parameters of coagulation will gradually return to normal range at 7 d after injury.