急性单发性创伤性脑损伤相关性凝血病的危险因素分析

Risk factors for coagulopathy in acute isolated traumatic brain injury

目的探讨急性单发性创伤性脑损伤（TBI）的凝血功能异常的相关危险因素。方法回顾性分析2012年7月-2015年6月收治的急性单发性TBI患者191例，根据是否出现凝血功能障碍将患者分为凝血障碍组（70例）和对照组（121例），利用多因素Loqistie回归分析患者年龄、性别、损伤类型、cT中线移位及TBI严重程度[格拉斯哥昏迷评分（GCS）]中凝血病的独立危险因素，并进一步分析该独立危险因素与各凝血指标的相关性。结果多因素Logistic回归分析结果表明，损伤严重程度、急性硬膜下血肿、脑室内出血及cT中线移位是其独立危险因素（P〈0．05，DR〉1）。损伤严重程度和急性硬膜下血肿分别与国际标准化比值（INR）和纤维蛋白原（Fg）异常相关（P〈0．05或〈0．01）；脑室内出血则与凝血酶原时间（PT）和血小板计数（PC）异常相关（P〈0．01）；CT中线移位则分别与Fg和血小板异常相关（P〈0．05）。结论损伤严重程度、急性硬膜下血肿、脑室内出血和CT中线移位是急性单发性TBI相关性凝血病的独立危险因素，且该因素与相应凝血功能指标异常相关。提示TBI发生后需严密监测凝血功能指标的变化，及早发现并处理TBI相关性凝血病。

Objective To discuss the risk factors for coagulopathy in acute isolated traumatic brain injury （TBI）. Methods A retrospective study was performed on 191 patients with acute isolated TBI hospitalized from July 2012 to June 2015. There were 70 patients with coagulopathy （ coagulopathy group） and 121 patients without coagulopathy （control group）. Age, gender, injury type, midline shift on CT and injury severity （Glasgow Coma Scale, GCS） were analyzed to identify the independent risk factors for coagulopathy using the logistic regression analysis. Correlation between the independent risk factors and coagulation indices was analyzed. Results Injury severity, acute subdural hematoma, intraventricular bleeding and midline shift on CT were identified as the independent risk factors for coagulopathy（ P 〈 0.05, OR 〉 1 ） . Furthermore, injury severity and acute subdural hematoma were respectively associated with abnormalities of international normalized ratio （INR） and fibrinogen （Fg） （P 〈0.05 or P 〈 0.01 ）, intraventricular bleeding with abnormalities of prothrombin time （PT） and platelet count （PC） （ P 〈 0.01 ）, and midline shift on CT with abnormalities of Fg and PC （ P 〈 0.05 ）. Conclusions Injury severity, acute subdural hematoma, intraventricular bleeding and midline shift on CT are independent risk factors for coagulopathy in patients with acute isolated TBI, and correlate withabnormalities of several coagulation indices. Changes in coagulation indices should be monitored accurately after TBI, and timely treatment of coagulopathy can improve the prognosis.