脑挫伤后的进展性脑挫伤与凝血指标变化的临床研究

Hemorrhagic progression of cerebral contusion and changes of coagulation indexes

目的通过对进展性脑挫伤患者的凝血指标进行动态检测,探讨在进展过程中关键凝血指标的变化。方法对95例进展性脑挫伤患者进行临床资料分析,检测伤后24 h^7 d内格拉斯哥昏迷评分(GCS)、凝血酶原时间(PT)、激活部分凝血酶原时间(APTT)、纤维蛋白原含量(FIB)、D-二聚体浓度(D-dimer)、纤维蛋白降解产物(FDP)以及其变化趋势。分析其中与死亡率、格拉斯哥预后评分(GOS)相关的危险因素。结果进展性脑挫伤各组患者中入院评分、D-二聚体及纤维蛋白原含量与死亡率、GOS评分相关。结论凝血指标对进展性脑挫伤患者预后判断具有临床指导意义,入院评分越低,D-二聚体浓度越高,纤维蛋白原含量越高预后越差。其中以双额叶及颞叶部位进展性脑挫伤预后较差。

【Objective】 To continuously detect the coagulation indexes in cerebral contusion patients with progressive hemorrhage so as to investigate the changes of coagulation indexes in hemorrhagic progression of contusion. 【Methods】 The clinical data of 95 patients with hemorrhagic progression of contusion were analyzed. Within 24 h-7 d after injury, the score of the Glasgow Coma Scale（GCS）, prothrombin time（PT）, activated partial thromboplastin time（APTT）, fibrinogen（FIB）, D-dimer concentration（D-dimer） and fibrin degradation products（FDP） were tested and the variation trend was analyzed. The risk factors releted to the mortality rate and GCS score were identified. 【Results】 The admission score, the content of D-dimer and fibrinogen of the cerebral contusion patients with progressive hemorrhage were interrelated with the mortality rate and GCS score. 【Conclusions】 The coagulation indexes have clinical significances in prediction of prognosis in patients with progressive cerebral contusion. The lower the admission score is, the higher the concentration of D-dimer the fibrinogen content are, the poorer the prognosis is. Especially the patients with progressive contusion of bilateral frontal and temporal lobes have poor prognosis.