亚低温对重型颅脑创伤合并急性创伤性凝血病患者的影响及临床意义

Discussion of impact and clinical significance of mild hypothermia on patients with severe traumatic brain injury combined acute traumatic coagulopathy

目的：观察亚低温与常温对重型颅脑创伤（severe traumatic brain injury ，sTBI）合并急性创伤性凝血病患者的影响。方法纳入70例sTBI合并急性创伤性凝血病患者，根据治疗方案的不同分组。对照组给予36.5～37.5℃常温状态下常规治疗，研究组在直肠温度（rectum temperature ，RT ）32.5～34.5℃的亚低温状态下常规治疗。对2组患者的血浆凝血酶原时间（prothrombin time ，PT）、活化部分凝血活酶时间（activated partial thromboplastin time ，APTT）、凝血酶时间（throm‐bin time ，TT）、血浆纤维蛋白原含量（fibrinogen ，Fg）、D‐二聚体（D‐dimer ，DD）等进行72 h监测，分析sTBI合并急性创伤性凝血病患者受伤后早期高凝状态的变化规律，对患者住院期间并发症情况进行统计。结果治疗前2组患者 PT、APTT、TT、Fg以及DD水平均无明显差异（P＞0.05）。治疗后研究组患者PT、APTT、TT、DD水平明显低于对照组（P＜0.05），Fg水平明显高于对照组（P＜0.05）。研究组迟发性血肿、纤溶亢进、脑梗死并发症发生率分别为8.57％、2.86％、0％，对照组迟发性血肿、纤溶亢进、脑梗死并发症发生率分别为5.71％、34.29％、25.71％，研究组并发症发生率低于对照组（ P＜0.05）。结论亚低温治疗sTBI合并急性创伤性凝血病，能够有效缓解患者高凝状况，减少凝血因子的消耗，进而抑制继发的纤溶亢进。

Objective To observe the impact of mild hypothermia and normal temperature on patients with STBI combined ATC. Methods 70 patients with STBI combined ATC were chosen and were divided into groups according to different treat‐ment methods. Control group was given routine treatment under 36.5‐37.5 ℃ while study group was given routine treatment under mild hypothermia of rectum temperature of 32.5‐34.5 ℃. PT ,APTT ,TT ,Fg and DD of two groups were monitored for 72 hours. The changes of early stage after injury hypercoagulability of patients with STBI combined ATC were analyzed. Besides ,complications of patients during hospitalization were counted.Results Before treatment ,there were no significant differences between the two groups on PT ,APTT ,TT ,Fg and DD levels （P〈0.05）. After treatment ,PT ,APTT ,TT and DD levels of study group were obviously lower than control group （P〈0.05） and Fg level was obviously higher than control group （P〈0.05）. Delayed hematoma ,hyperfibrinolysis and cerebral infarction of study group were separately accounted for 8.57% ,2.86% and 0 ,while those of control group were separately 5.71% ,34.29% and 25.71%. The rates of hyperfibrinol‐ysis and cerebral infarction of study group were lower than control group （P〈0.05）.Conclusion Mild hypothermia for pa‐tients with STBI combined ATC can effectively relieve hypercoagulability of patients and reduce consumption of blood coagula‐tion factor and thus inhibit secondary hyperfibrinolysis.