颅脑损伤患者早期凝血纤溶功能变化与迟发性颅内出血及预后的相关性探讨

Study on the relationship between early blood coagulation fibrinolysis and delayed intracranial hemorrhage and prognosis in traumatic brain injury

目的探讨颅脑损伤患者早期凝血纤溶功能变化与迟发性颅内出血及预后的关系。方法根据格拉斯哥评分(GCS),将河北大学附属医院收治的142例颅脑损伤患者分为轻型组47例,中型组39例,重型组56例,同时选取50例健康体检者作为对照组,检测其入院时凝血纤溶功能指标。治疗1个月后按是否出现迟发性颅内出血将患者分为无迟发性颅内出血组(93例)和迟发性颅内出血组(49例)。比较不同组之间凝血纤溶功能指标。结果各型颅脑损伤中凝血纤溶功能均有异常,且随着伤情的加重,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、D-二聚体(DD)水平逐渐升高,而血小板(PLT)水平逐渐下降(P<0.05)。与无迟发性颅内出血组比较,迟发性颅内出血组PT、APTT、TT和DD水平明显升高,PLT水平明显降低(P<0.05)。结论颅脑损伤后存在凝血功能异常,且其与迟发性颅内出血的发生密切相关。早期凝血纤溶功能检测有助于判断颅脑损伤的伤情,改善患者预后。

Objective To explore the relationship between early blood coagulation fibrinolysis and delayed intracranial hemorrhage and prognosis in traumatic brain injury. Methods 142 traumatic brain injury patients who were treated in our hospital were divided into mild （n = 47）, moderate （n = 39）, severe injury （n = 56） groups according to GCS, and compared with 50 example physical exam. The coagulant function indicators were measured on admission. After one month treatment, patients were regrouped as non-delayed intracranial hemorrhage group （n = 93） and delayed intracranial hemorrhage group （n--49）, and all the indicators of blood coagulation fibrinolysis were compared among the groups. Results All the traumatic brain injury patients had the disturbance of blood coagulation fibrinolysis, and with the severity aggravating, the level of PT, APTT, TT and DD were increased, and PLT was decreased （P 〈 0.05）. Compared with non-delayed intracranial hem- orrhage group, the levels of PT, APTT, TT and DD were markedly increased, while the level of PLT was considerably re- duced in delayed intraeranial hemorrhage group （P 〈 0.05）. Conclusion Blood coagulation fibrinolysis occurs after trau- matic brain injury, and it is closely related with delayed intraeranial hemorrhage. Monitoring blood coagulation fibrinolysis early can help judge the severity of traumatic brain injury, and improve the prognosis.