颅脑外伤迟发性颅内出血与凝血机制异常的临床观察

A clinical study on correlation between delayed intracranial hemorrhage and abnormal coagulation

目的观察颅脑外伤后发生迟发性颅内出血以及凝血机制异常之间的关系,为临床工作提供借鉴。方法223例颅脑外伤患者,其中32例发生迟发性颅内出血(出血组),其余191例患者未发生出血(非出血组)。分析迟发性颅内出血的相关危险因素,对比两组患者的各项凝血功能指标。结果 Logistic多因素相关分析结果证实凝血机制异常是颅脑外伤后发生迟发性颅内出血的独立危险因素。共有32例患者发生迟发性颅内出血,其凝血酶时间、凝血酶原时间、活化部分凝血酶原时间、凝血酶原国际标准化比率均大于非出血组(P<0.05),而出血组的血小板计数则低于非出血组,尤其是有2项及以上的凝血指标发生异常时,出血发生可能性更大(P<0.05)。结论凝血功能异常是颅脑外伤后发生迟发性颅内出血的独立危险因素,尤其是异常指标达到或超过2项时更易导致颅内出血,临床工作中应引起重视,及时预防。

Objective To observe the relationship between delayed intracranial hemorrhage and abnormal coagulation after brain injury. Methods A total of 223 patients with traumatic brain injury were allocated in this study. Among them,32 patients with delayed intracranial hem-orrhage were allocated in bleeding group,and the other 191 patients without bleeding were listed in non - bleeding group. The correlation between delayed intracranial hemorrhage and other related factors were analyzed,and the indexes of coagulation in patients of these two groups were com-pared. Results Logistic multiple factor correlation analysis confirmed that abnormal coagulation was an independent risk factor of delayed intracra-nial hemorrhage. Among 32 patients with delayed intracranial hemorrhage,the thrombin time,prothrombin time,activated partial thromboplastin time,and international standardizedprothrombin ratio were significantly different in comparison with those of patients in non - bleeding group（ P﹤ 0. 05）,and platelet count was lower than that of non - bleeding group,especially the number of abnormal coagulation indexes reached 2 items or above（ P ﹤ 0. 05）. Conclusion The abnormality of coagulation is the independent risk factor for delayed intracranial hemorrhage after trau-matic injury of brain,especially when the abnormal indexes reached 2 itemsor above that would easily lead to intracranial hemorrhage,and atten-tion should be paid in clinical work for prevention in time.