颅脑损伤急性期凝血功能异常75例临床分析

Clinical analysis of early blood coagulation dysfunction in patients with traumatic brain injury

目的探讨颅脑损伤(TBI)患者急性期凝血功能异常与病情严重程度、是否发生进展性颅内出血(PIH)以及预后的关系。方法选择75例TBI患者,按GCS评分分为重型TBI组(GCS3～8分)和轻中型TBI组(GCS>8分);按病情进展分为PIH组和非PIH组;治疗15d后,按病情预后分为预后不良组和预后良好组。所有患者在入院24h内测定凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FBG)和血小板(PLT),并进行数据分析。结果急性TBI患者在发病24h内发生凝血功能异常。重型TBI组PT、FBG和PLT异常较轻中型TBI组明显,PIH组PT、APTT、FBG和PLT异常较非PIH组明显,预后不良组PT、APTT、FBG和PLT异常较预后良好组明显,差异均有统计学意义(P<0.05)。结论 TBI患者急性期常见凝血功能异常,早期监测PT、APTT、FBG和PLT对判断TBI的严重程度和估计预后有重要临床意义,可以预测进展性颅内血肿发生。

Objective To investigate the correlations among early blood coagulation dysfunction,severity,progressive intracranial hemorrhage （PIH） and prognosis in the patients with traumatic brain injury （TBI）. Methods Seventy-five patients with TBI were divided into severe TBI group （GCS 3 ～8） and mild-to-moderate TBI group （GCS〉8）,according to GCS scores. They were then divided into PIH group and non-PIH group on the basis of further development. After 15 d treatment,they were separated into poor prognosis group and favorable prognosis group. PT,APTT,FBG and PLT levels were determined and analyzed at 24 h after admission. Results Blood coagulation dysfunction occurred in all the patients with TBI within 24 h. PT,FBG and PLT levels were higher in the severe TBI group than the mild-to-moderate TBI group. In the PIH group and the poor prognosis group,PT,FBG,APTT and PLT levels were markedly higher than the non-PIH group and the favorable prognosis group,respectively. There were significant differences among all the groups （P〈0.05）. Conclusions Early blood coagulation dysfunction is common in patients with TBI. Early monitoring PT,APTT,FBG and PLT levels can help to assess the severity,judge the prognosis,and prevent PIH.