28例重型脑伤患者肝功能指标变化及预后分析

The Changes of Liver Function Indicators and Prognostic Analysis in 28 Patients with Severe Traumatic Brain Injury

目的：探讨重型颅脑损伤患者在不同时段肝功能指标的变化情况及其与患者预后的关系。方法：总结28例重型颅脑损伤患者的临床资料,分析早期、中期、中后期各阶段格拉斯哥评分（GCS）、颅内压（ICP）、总胆红素（TB）、总蛋白（TP）、白蛋白（ALB）、谷丙转氨酶（ALT）、谷草转氨酶（AST）等指标变化情况及患者预后。结果：重型颅脑损伤患者肝功能在早期有20%（28/140）异常,中期60.7%（85/140）异常,中后期21.1%（19/90）异常;恢复良好组和重残（死亡）组,在入院早期以及中后期的肝功能指标未见显著差异,但在中期的指标仍然有一定的差异,重残组和恢复良好组中期的ALT和AST比较差异有统计学意义（P〈0.05）。结论：重型颅脑损伤患者肝功能异常在3~5 d最为明显,而肝功能异常程度愈大的患者预后愈差。

Objective： To investigate the changes of liver function indicators in the severe traumatic brain injury patients at different times and its relationship with prognosis. Method： With clinical data of the Glasgow Coma Score （ GCS ）, intracranial pressure （ ICP ）, total bilirubin （ TB ）, total protein （ TP ）, albumin （ ALB ）, alanine aminotransferase （ ALT ）, aspartate aminotransferase （ AST ） and other indicators in 28 cases of severe traumatic brain injury, the changes of these indicators and its relationship with prognosis were analyzed. Result： Patients with severe traumatic brain injury had different extent damage in liver function at different time, 20% （ 28/140 ） in the early stage, 60.7% （ 85/140 ） in the medium stage and 21.1% （ 19/90 ） in the late stage. The recovered well group and the heavy remnants （ death ） group, in the early admission and liver function index had no significant differences in the middle, but in the middle of the index still had certain difference, severely medium-term SLT and AST comparative difference of two groups was statistically significant （P〈0.05） . Conclusion： Liver function damage is most obvious in 3-5 days in,patients with severe traumatic brain injury, and the patients with more severe liver function damage have worse prognosis.