颅脑创伤患者开颅前凝血功能障碍与颅脑损伤程度及预后的相关性

Correlation of coagulation dysfunction before craniotomy,severity and prognosis of patients with traumatic brain injury

目的 探究凝血功能障碍在颅脑创伤急诊开颅前的发生率及其与患者损伤严重程度和预后的相关性.方法 选择2015年3月至2017年3月齐河县人民医院急诊接收并行开颅手术治疗的70例颅脑创伤患者为研究对象,另选择同期健康体检者30例作为对照组.70例颅脑创伤患者根据入院时格拉斯哥昏迷评分（GCS）分为轻型组、中型组和重型组,比较三组凝血功能障碍发生率和各项凝血功能指标;根据是否发生凝血功能障碍分为凝血功能障碍组和非凝血功能障碍组,比较组间预后情况;根据预后恢复情况分为预后良好组和预后不良组,比较凝血功能障碍发生率和各项凝血功能指标.结果 对照组、轻型组、中型组和重型组凝血功能障碍发生率（0.00％比35.00％、50.00％、77.27％）、血浆凝血酶原时间[PT,（10.34±0.28）s比（12.01±0.33）、（13.53±0.41）、（15.22±0.50）s]、活化部分凝血酶原时间[APTT,（28.53±2.31）s比（32.63±3.20）、（35.69±3.02）、（39.74±4.01）s]、纤维蛋白原[FIB,（3.12±0.45）g/L比（2.58±0.30）、（2.21±0.32）、（1.82±0.41）g/L]、国际标准化比值（INR,0.91±0.04比1.04±0.06、1.13±0.05、1.23±0.06）比较差异均有统计学意义（P均〈0.05）;凝血功能障碍组和非凝血功能障碍组预后良好率（55.26％比84.38％）和预后不良率（44.74％比15.62％）比较差异有统计学意义（P〈0.05）;预后良好组和预后不良组凝血功能障碍发生率（26.32％比85.71％）、INR（1.01±0.05比1.29±0.07）、PT[（12.45±0.47）s比（16.35±0.61）s]、APTT[（33.04±5.81）s比（40.03±5.24）s]和FIB[（2.40±0.51）g/L比（1.80±0.60）g/L]比较差异有统计学意义（P〈0.05）.结论 颅脑创伤患者凝血功能障碍的发生率会随着创伤的严重程度增加而增加,并严重影响患者的预后.

Objective To investigate the incidence of coagulation dysfunction before craniotomy and its correlation with the severity and prognosis of patients with traumatic brain injury. Methods Seventy patients with traumatic brain injury treated by craniotomy in Qihe People＇s Hospital from March 2015 to March 2017 were selected as research objects. According to the patient＇s Glasgow coma score（GCS） at admission, patients were divided into mild group, medium group and severe group to compare blood coagulation dysfunction and the coagulation indexes. The patients were divided into coagulation disorder group and non coagulation disorder group according to whether had coagulopathy or not to compare the prognosis between the two groups. According to the prognosis, patients were divided into good prognosis group and poor prognosis group to compare the incidence of coagulation dysfunction and coagulation function indexes between the two groups. Results The incidence of coagulation disorders （0.00% vs. 35.00%, 50. 00%, 77.27% ）, prothrombin time [ PT, （ 10. 34 ±0. 28） s vs. （ 12. 01 ± 0. 33） s, （ 13.53± 0. 41 ） s, （15. 22 ±0. 50）s], activated partial thromboplastin time [APTF, （28. 53 ±2. 31 ）s vs. （32. 63 ±3.20）s, （35.69±3.02）s, （39.74±4.01）s], fibrinogen [FIB, （3.12±0.45）g/L vs. （2.58±0.30）g/L, （2.21 ± 0. 32） g/L, （ 1.82 ±0. 41 ） g/L] and international normalized ratio （ INR, 0. 91 ± 0. 04 vs. 1.04 ± 0. 06, 1.13 ± 0. 05, 1.23 ± 0. 06 ）, in control group, light group, medium group and severe group of traumatic brain injury patients were significantly different （P 〈 0. 05 ）. There were significant differences in the rate of good prognosis （ 55.26% vs. 84.38% ） and poor prognosis （ 44. 74% vs. 15.62% ） between coagulation dysfunction group and non coagulation dysfunction group （P 〈 0.05 ）. The incidence of coagulation disorders （26. 32% vs. 85.71% ）, INR （ 1.01 ±0. 05 vs. 1.29 ±0. 07）, PT [ （12. 45 ±0. 47）s vs. （16.35 ±0.61）s], APTT [（33.04±5.81）s vs. （40.03 ±5.24）s] and FIB [ （2.40 ± 0. 51 ） g/L vs. （ 1.80 ± 0. 60） g/L ] were significantly different between good prognosis group and poor prognosis group （P 〈 0. 05 ）. Conclusions The incidence of coagulation dysfunction in patients with traumatic brain injury increases with the severity of trauma, and will seriously influence the prognosis of patients.