中重型创伤性颅脑损伤患者凝血功能变化及对预后的影响

The changes of coagulation function and its influence on prognosis in patients with moderate and severe traumatic brain injury

目的探讨中重型创伤性颅脑损伤患者凝血功能变化及对预后的影响。方法选取我院2014年8月至2017年8月诊治的中型创伤性颅脑损伤患者57例为A组,重型创伤性颅脑损伤患者39例为B组,健康体检者41例为对照组,均行凝血功能指标检测,并于伤后1个月评估3组患者的预后。结果 A组伤后4、12、24、48、72 h凝血功能指标(凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、D-二聚体、纤维蛋白降解产物)高于对照组(P <0. 05)。B组伤后4、12、24、48、72 h凝血功能指标(凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、D-二聚体、纤维蛋白降解产物)高于对照组和A组(P <0. 05)。伤后12 h内A组与B组凝血功能指标增加;伤后12 h后A组与B组凝血功能指标降低(P <0. 05)。A组GOS评分高于B组(P <0. 05),预后评分分布好于B组(P <0. 05)。结论创伤性颅脑损伤患者在伤后早期就可发生凝血功能障碍,病情越严重,凝血功能障碍越明显,预后越差。

To investigate the changes of coagulation function and its influence on prognosis in patients with moderate and severe traumatic brain injury.From August 2014 to August 2017,our hospital treated 57 patients with moderate traumatic brain injury were enrolled in group A,39 patients with severe traumatic brain injury in group B,and 41 health checkup people were taken as control group.The blood coagulation function in all subjects was detected.Prognosis of the patients was evaluated 1 month after injury.Coagulation function indexes(PT,APTT,TT,DD and FDP)at 4,12,24,48 and 72 hours after injury in the group A were higher than those in the control group(P<0.05).The coagulation function indexes after injury in the group B were higher than that those in the control group and the group A(P<0.05).Within 12 hours after injury,the coagulation function indexes in the group A and B were increased while the indexes in the group A and B were decreased after 12 h of injury(P<0.05).The GOS score in the group A was higher than that in the group B(P<0.05).Prognostic score distribution in the group A was better than that in the group B(P<0.05).Coagulation dysfunction may occur in patients with traumatic brain injury at the early stage of injury.The more serious the brain injury is,the more obvious the coagulation dysfunction and the worse the prognosis are.