急性颅脑损伤后出血与凝血功能的关系

目的探讨急性颅脑损伤患者凝血功能的变化及其与进展性颅内出血(progressive intracranial hemorrhage,PIH)的关系。方法据格拉斯哥昏迷评分(GCS),将106例颅脑损伤患者分为轻、中、重度三组,测定其入院时的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、血小板计数(PLT)、纤维蛋白原(Fg)和D-二聚体(DD)的水平,并与50例健康体检者(对照组)对照。通过头颅CT表现,确定颅脑损伤患者是否发生PIH,分析凝血功能变化与PIH的关系。结果颅脑损伤者PT、APTT和DD水平明显高于对照组,PLT、Fg低于对照组(P<0.05),随着伤情加重,颅脑损伤者PT、APTT及DD水平依次增加,而PLT、Fg依次下降(P<0.01);与非PIH者相比,PIH者PT、DD明显升高,Fg明显下降(P<0.05)。结论急性颅脑损伤患者凝血功能异常,其程度与颅脑损伤程度密切相关,早期监测凝血功能有助于判断颅脑损伤的严重程度及预测PIH的发生。

Objective To investigate the changement of blood coagulation function and the correlations among early blood coagulation dysfunction and progressive intraeranial hemorrhage （PIH） in the patients with traumatic brain injury （TBI）. Methods 106 patients with TBI were divided into mild, moderate and severe injury groups based on GCS, the levels of PT, APTT, TT, PLT, Fg and DD were measured on admission, compared with those in 50 healthy controls（control group）. They were then divided into PIH group and non-PIH group on the basis of head CT scan. And the correlations among blood coagulation dysfunction and P1H was analyzed. Results Compared with control group, the levels of PT, APTT and DD were elevated signally, while the level of PLT and Fg decreased in the patients with TBI, The levels ofPT, APTT and DD were progressively elevated with increasing disease severity, while the PLT and FG level was decreased （P〈 0.01）., Compared with non-PIH group, the PT and DD levels were markedly higher, and the Fg level was lower in PTH group.Conclusion Early blood coagulation dysfunction is common in patients with TBI. and which is associated closely with the injury severity, Early monitoring blood coagulation function can help to assess the severity and predict the occurance of PIH.