多发伤合并中重型颅脑损伤凝血功能障碍的相关因素分析

Analysis of factors associated with coagulation dysfunction in patients with multiple trauma and moderate/severe brain injury

目的探讨多发伤合并中重型颅脑损伤患者凝血功能障碍的相关因素。方法回顾性分析天津市人民医院神经外科2007年1月~2014年1月收治的120例多发伤合并中重型颅脑损伤患者的临床资料,根据入院48h凝血功能检查,分为凝血功能障碍组(A组,68例)与非凝血功能障碍组(B组,52例),对患者性别、年龄、吸烟史、酗酒史、格拉斯哥昏迷评分(GCS评分)、休克、合并伤情况、颅内出血情况、液体复苏等因素进行统计学分析。结果两组在年龄、性别、吸烟史对比无统计学意义(P>0.05)。凝血功能障碍与休克(OR=3.073,P=0.036)、重型颅脑损伤(OR=1.794,P<0.001)、液体复苏(OR=0.312,P=0.035)、多发脑挫裂伤情况(OR=2.911,P=0.040)、合并胸腹部损伤(OR=3.008,P=0.041)及酗酒史(OR=2.664,P=0.047)相关。伤后6个月随访,两组预后格拉斯哥预后评分(GOS评分)组间比较采用Ridit分析(R值A=0.613,R值B=0.464,t=2.107,P=0.046),非凝血功能障碍组优于凝血功能障碍组。结论多发伤合并中重型颅脑损伤患者凝血功能是影响预后的重要因素,合并休克、胸腹部损伤及多发脑挫裂伤患者更易出现凝血功能障碍,限制性液体复苏可能减少凝血功能障碍的发生,对改善患者预后有一定益处。

Objective To study the factors associated with coagulation dysfunction in patients with multiple trauma combined with moderate/severe brain injury.Methods Clinical data of 120 patients from Jan.2007 to Jan.2014 suffered multiple trauma combined with brain injury were retrospectively reviewed.Coagulation function tests were performed at 48 hours after admission.The patients were divided into two groups,68 cases in group A had coagulation dysfunction,and 52 cases in group B had not.The factors potentially associated with coagulation dysfunction as age,gender,smoking history,alcoholism,GCS,shock index,combined injuries,intracranial hemorrhage,fluid resuscitation were statistically analyzed.Results There was no significant difference in the characteristics of age,gender and smoking history between the two groups（P〈0.05）.While shock（OR = 3.073,P = 0.036）,severe brain injury（OR = 1.794,P〈0.001）,fluid resuscitation（OR = 0.312,P = 0.035）,multiple cerebral contusion and laceration（OR = 2.911,P = 0.040）,combined thoracic and/or abdominal injury（OR = 3.008,P = 0.041）,alcoholism（OR = 2.664,P = 0.047）,were significantly related to coagulation dysfunction.After 6 months of follow-up,the Glasgow outcome scale of the patients in group B was better than that in group A by Ridit Analysis（RiditA= 0.613,RiditB= 0.464,t = 2.107,P = 0.046）.Conclusion The coagulation function is one of the important factors which affect prognosis of patients with multiple trauma combined with moderate/severe brain injury.The patients combined with shock,thoracic and/or abdominal injury,multiple cerebral contusion and laceration are apt to develop coagulation dysfunction.Limited fluid resuscitation can reduce the probability of coagulation dysfunction,and further improve the outcome.