颅脑损伤患者急性期凝血功能及D-二聚体改变的临床研究

Clinical research on coagulation function and D-dimer in the acute stage of craniocerebral injury

目的探讨急性颅脑损伤患者凝血功能的变化特点以及其与颅脑损伤严重程度和预后的关系。方法回顾性分析75例重庆市第五人民医院2012-01—2014-02收治的急性单纯性重型颅脑损伤患者的临床资料,监测血浆PT、APTT、TT、Fbg和D-二聚体,分析GOS评分与凝血指标的关系、继发性颅内血肿与凝血指标的关系、继发外伤性脑梗死与凝血指标的关系,以及D-二聚体与伤情(GCS评分)、预后(GOS评分)的关系。结果 GOS评分不同组间TT、Fbg差异有统计学意义(P<0.05);有无继发性颅内出血者PT、Fbg差异有统计学意义(P<0.05),有无继发外伤性脑梗死者PT、APTT差异有统计学意义(P<0.05);D-二聚体在GCS评分越低组阳性率越高,差异有统计学意义(P<0.05);GOS评分预后不良(1~3分)组D-二聚体阳性率比预后良好(4~5分)组高,差异有统计学意义(P<0.05)。结论单纯性重型颅脑损伤患者伤后PT、APTT、TT、Fbg和D-二聚体能较好反映颅脑损伤后凝血纤溶状态,其中D-二聚体是一个敏感性和特异性较好的指标。颅脑损伤越重,凝血功能紊乱越明显;凝血功能紊乱越明显,预后越差,其可作为预后的评估指标。

Objective To investigate the association between the change of coagulaltion function, severity of crank）cerebral injury and prognosis of patients with acute craniocerebral injury. Methods The PT, APTT,Fbg and D-dimer were observed dy namically in the plasma of patients in the acute stage with severe craniocerebral injury. The association between coagulahion func tion and prognosis of craniocerebral injury was analyzed statistically. Results The PT level in patients with secondary intracranial hematoma was significantly differed from patients without it. PT was also different in patients with and without traumatic cerebral infarction. The APTT level in patients with traumatic cerebral infarction was differed from patients without it. The patients with different （.X2S scores and with or without secondary intracranial hematoma showed different levels of Fbg. The positive rate of D- dimer was significantly associated with score of GCS. The positive rate of D dimer in patients with GOS score （1-3） was higher than that in patients with GOS score （4-5）. Conclusion The levels of PT,PT,APTT,TT and Fbg in patients with simple and sever craniocerebral injury can reflect the coagulation and fibrinolysis after injury. Among them,D-dimer is a specific and sensitive marker. The severity of craniocerebral injury is positively correlated with coagulation disorder, the more serious the coagulation disorder is, the worse prognosis is.