高原地区颅脑损伤后凝血功能异常的临床分析

Surgical treatment of coagulation blood dysfunction in patients with acute craniocerebral trauma at plateau area

目的总结高原地区颅脑损伤后凝血功能障碍的临床特征及诊治经验。方法 2002年6月至2012年6月共收治高原地区颅脑损伤后凝血功能障碍患者62例,监测血清D-二聚体、纤维蛋白降解产物(FDP)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、血小板计数(BPC)。对于凝血指标异常、处于高凝状态(血清D-二聚体>0.5μg/ml、FDP>8 mg/L)患者在10 d后给予干预治疗(低分子肝素钠2 500 U,皮下注射,12 h 1次),深静脉血栓形成应用尿激酶干预(20万单位,静脉滴注,每天一次)。结果本组62例患者存活52例,均预后良好;死亡10例,其中弥散性血管内凝血2例,PT延长2例,持续高凝状态不能纠正6例。结论高原地区颅脑损伤后高凝状态发生率高,加剧再次颅脑损伤;一旦发生死亡率很高,早期对高凝状态的干预治疗可降低患者死亡率。

Objective To prevent the secondary injury and improve prognosis in the patients with coagulation blood dysfunction after the cranioeerebral trauma at plateau area. Methods The examinations of the venous blood drown at 7 a.m. showed that the coagulation blood dysfunction （hypereoagnlable state） occurred in 62 patients with acute craniocerebral trauma treated in our department from June, 2002 to June, 2012, including D-dimer, fibrin degradation products （FDP）, prothrombin time （PT）, activated partial thrombin time （APTT）, and platelet counts （BPC）. Two thousand five hundred units of low molecular weight heparin sodium were subcutaneously injected once every 12 hours 10 days after the injury in all the patients with hypercoagulabe state. Two hundred thousand units of urokinae were intravenously infused once every day in the patients with hypercoagulability complicated by deep vein thrombosis. Results Of 62 patients with blood hypercoagulability after the acute eraniocerebral trauma, 52 survived and 10 died from the intractable blood hypercoagulability. All the survival patients were recovered well. Conclusions The incidence of hypercoagulable state after the craniocerebral trauma at plateau area is higher than that at plain area. There is high mortality in the patients with blood hypereoagnlability after the acute crainiocerebral trauma, in whom the mortality may be decreased by the treatment directed at the hypercoagnlability.