颅脑外伤后进展性脑内出血与凝血功能异常的关系

Relationship of progressive intracranial hemorrhage after craniocerebral trauma and dysfunction of blood coagulation

目的探讨急性颅脑损伤患者凝血与纤溶功能变化与进展性脑内出血(PIH)的关系。方法根据头颅CT的表现,662例颅脑损伤患者分为PIH组(151例)及非PIH组(511例),于伤后6h内、24h和7d动态监测血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TT)、国际标准化率(INR)和D-二聚体(D-D)。并取健康体检者作为对照组(50例),分析凝血纤溶变化与PIH的相关性。结果三组PT、Fib和INR在入院时,24h及7d时差异均无统计学意义(P>0.05)。PIH组TT在入院时及24h高于非PIH组及对照组(P<0.05),PIH组APTT在24h上升高于其他两组(P<0.01)。在入院时及24h,PIH组D-D高于非PIH组及对照组(P<0.01)。结论动态监测APTT、TT及D-D变化对预示颅脑外伤后PIH有重要意义。

Objective To investigate the relationship of progressive intracranial hemorrhage （PIH） after craniocerebral trauma and dysfunction of blood coagulation in the patients with acute craniocerebral injury. Methods On the basis of CT diagnosis, 662 patients with acute craniocerebral injury were assigned into two groups of A（with PIH, 151 cases） and B（without PIH, 511 cases）. Fifty healthy people were taken as the controls（group C）. Plasma prothrombin time（PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fib）, thrombin time （TT）, international normalized ratio （INR） and D-dimer（D-D） were detected within 6 hours after injury（T1）,at 24 hours（T2） and on the 7th day（T3） after cerebral injury. The relationship between PIH and the changes of coagulation and fibrinolysis was analyzed. Results There were no significan differences in PT, Fib and INR at T1, T2 and T3 among three groups（P〉0. 05）. The values of TT at T1 and T2 were higher in group A than those in groups of B and C（P〉0.05）. The increase of APTT at T2 was more in group A than that in groups of B and C（P〈0. 01）. The values of D-D at T1 and T2 were higher in group A than those in groups of B and C（P〈0. 01）. Conclusion Dynamic monitoring of the changes of APTT,TT and D-D has an important significance in predicting PIH in the patients with acute craniocerebral injury.