重型颅脑损伤患者凝血功能的变化及临床意义

Changes of coagulation function in patients with severe traumatic brain injury

目的研究重型颅脑损伤后患者凝血功能的变化及其对预后判断的价值。方法选取126例重型颅脑损伤患者，分别在入院急诊时（D0）及入院后第1（D1）、3（D3）、7（D7）天检测活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、凝血酶时间（TT）、纤维蛋白原（Fbg）和D-二聚体（DD）。并以同期126例单纯头皮裂伤患者作为对照组，D0检测凝血功能指标。对两组患者的检测结果进行统计学分析，并以重型颅脑损伤患者外伤后1个月GOS分值作为划分预后标准（GOS3～5分为预后良好组，GOS1～2分为预后不良组），对两组D0期的凝血功能检测结果进行分析和比较。结果在D0期，重型颅脑损伤患者APTT、PT、TT均明显缩短，Fbg明显减少，DD明显增高（均P〈0．05）。而后APTT、PT在D1开始延长，至D3达高峰，D7恢复正常；Fbg逐渐升高，至D3、D7达到正常；DD则逐渐下降，至D7恢复正常；TT在D1即恢复至正常范围。不同时期APTT、PT、Fbg及DD值的波动明显，差异均有统计学意义（均P〈0．05），TT则波动不明显。D0、D1、D3分别与D7比较，APTT、PT、Fbg及DD值的差异均有统计学意义（均P〈0．05），TT只在D0期差异有统计学意义（P〈0．05）。预后不良组与良好组比较，D0期APTT、PT、DD及Fbg值的差异均有统计学意义（均P〈0．05）。结论重型颅脑损伤患者的凝血功能异常较明显，测定相关凝血功能指标，对颅脑损伤的严重程度及预后判断有参考价值。

Objective To investigate the clinical significance of coagulation dysfuction in patients with severe traumatic brain injury（sTBI ）. Methods The activated partial thromboplastin time （APTT）, prothrombin time （PT）, thrombin time （TT）, fibrinogen （Fbg） and D-dimer （DD）, were measured in 126 patients with sTBI at admission （Do） and 1st （D1）, 3rd （D3）, 7th （DT） day after admission; and in 126 patients with simple scalp laceration（control group） at admission（Do）. The prognosis of patients was assessed by Glasgow Outcome Scale （GOS） at 1 month after injury; patients with GOS 3-4 was classified as good prognosis and those with GOS 1-2 as poor prognosis. Results Compared with the control group APTT, PT levels of sTBI patients were shorter at Do, reached to the peak at D3, then returned to normal level at the D7. Fbg was lowest at Do and gradually returned to normal level at D3 and D7. DD was highest at Do and returned to normal level at D7. TT was the lowest at Do and returned to normal level at D1. There were significant differences in APTT, PT, Fbg and DD levels of sTBI patients among time points of Do, D1, D3 and D7 （P〈 0.05）; TT level showed the significant difference only between Do and DT. There were significant differences in APTT, PT, Fbg and DD levels between good and poor prognosis groups （P〈0.05）. Conclusion Patients with sTBI present significant coagulation dysfunction, the changes of coagulation function after sTBI reflect the severity of brain injury and can be used as a prognostic factor.