凝血功能障碍与弥漫性轴索损伤严重程度及预后的关系

Correlation between coagulation disorder and diffuse axonal injury severity on the prognosis

目的探讨弥漫性轴索损伤（DAI）后患者凝血功能障碍与损伤严重程度及预后的关系。方法根据格拉斯哥昏迷评分（GCS）将84例伤后24h内人院的DAI患者分为轻、中、重度损伤三组，同时，根据格拉斯哥预后评分（GOS）将患者分为预后良好和预后不良两组，测定其凝血酶原时间（frr）、部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）、D-二聚体（D—D）及血小板（PLT），并与30例健康体检者进行对照，分析凝血功能障碍与损伤严重程度及预后的关系。结果DAI患者的PT、APTT、TT、D—D水平与对照组相比显著升高，而FIB、PLT水平则显著降低（P〈0．05），随着损伤程度加重，PT、AprIT、D—D水平依次升高，而FIB、PLT水平则依次降低（P〈0．05），与预后良好组相比，预后不良组的PT、APTT、Tr、D—D水平显著升高，而FIB、PLT水平则显著降低（P〈0．05）。结论DAI患者存在凝血功能障碍，其程度与损伤严重程度及预后密切相关，早期监测凝血功能指标有助于伤情判定、临床治疗和预后判断。

Objective To explore the correlation between coagulation disorder and diffuse axonal injury （DAI） severity on the prognosis. Methods Applying with Glasgow coma scale （GCS）, 84 DAI patients were divided into three groups, light, medium, and severe damaged. Simultaneously, all the patients were divided into good and poor prognosis groups according to the Glasgow outcome scale （GOS）. Their respective prothrombin time （PT）, activated partial thromboplastin time （APTT）, thrombin time （tiT）, fibrinogen （FIB）, D-direct （D-D）, and platelet （PLT） were measured, and the results were compared with the control group, a group of 30 healthy people. Results Comparing with the control group, the DAI patients＇ PT, AFYr, TT, D-D significantly increased, yet, their FIB and PLT were significantly lower （P〈0.05）. Along with more severe injury, PT, APTY, D-D increased successively, FIB, PLT were decreased （P〈0.05）. Compared with the good prognosis group, the poor prognosis group＇ s PT, APTr, TI＇, D-D were significantly elevated, and, FIB, PLT were significantly reduced （P〈0.05）. Conclusion Severity of coagulation disorders is considered being closely related to the degree of injury severity and its prognosis. Early monitoring on coagulation parameters may contribute to the accurate diagnosis, treatment, and prognosis.