高风险脑外伤患者预防静脉血栓栓塞症的抗凝时机与预后的关系

The relationship between the timing of prophylactic anticoagulation for venous thromboembolism and prognosis in the patients with high-risk traumatic brain injury

目的探讨高风险脑外伤患者预防静脉血栓栓塞症(VTE)的抗凝时机与预后的关系。方法回顾性分析宁波大学附属第一医院2018年1月至2023年12月收治的高风险脑外伤患者的临床资料。将外伤后4~5 d启动抗凝的患者分为A组(n=100),外伤后6~7 d启动抗凝的患者分为B组(n=124),比较两组患者的一般临床资料以及抗凝后脑出血增加、神经功能恶化、再次手术、VTE、其他部位出血、住院时间、病死率等指标。采用多因素Logistic回归分析影响高风险脑外伤患者脑出血增加及死亡的危险因素。结果A组患者脑出血增加(10.0%vs.3.2%)、再次手术(8.0%vs.1.6%)、神经功能恶化(9.0%vs.2.4%)及病死率(14.0%vs.5.6%)均显著高于B组(P均<0.05),A组住院时间显著长于B组[d:16.0(13.0,19.8)vs.12.0(11.0,15.8),P<0.05],两组VTE及其他部位出血比较差异无统计学意义(P均>0.05)。多因素Logistic回归分析显示,与B组比较,A组脑出血风险增加(OR=4.715,95%CI 1.316~16.899,P<0.05),死亡风险增加(OR=3.101,95%CI 1.124~8.551,P<0.05)。结论高风险脑外伤患者伤后6~7 d启动抗凝VTE发生率低,预后更优,可作为临床抗凝启动时机。

Objective To investigate the relationship between the timing of prophylactic anticoagulation for venous thromboembolism(VTE)and prognosis in the patients with high-risk traumatic brain injury(TBI).Methods The clinical data of high-risk TBI patients admitted to the First Affiliated Hospital of Ningbo University from January 2018 to December 2023 were retrospectively analyzed.The patients who started anticoagulation on the 4th and 5th day post-injury were included into group A,and the patients who started anticoagulation on the 6th to 7th day post-injury were included into group B.The general clinical data and the indicators such as increased intracerebral hemorrhage,neurological deterioration,reoperation,VTE occurrence,bleeding in other parts,length of hospital stay,and mortality rate were compared between the two groups after anticoagulation.Multivariate Logistic regression analysis was used to analyze the risk factors for increased intracerebral hemorrhage and the mortality in high-risk TBI patients.Results The increase in intracerebral hemorrhage(10.0%vs.3.2%),reoperation(8.0%vs.1.6%),neurological function deterioration(9.0%vs.2.4%),and mortality rate(14.0%vs.5.6%)were significantly higher in group A than in group B respectively(P<0.05),and the length of hospital stay was significantly longer in group A than in group B[d:16.0(13.0,19.8)vs.12.0(11.0,15.8),P<0.05],there was no significant difference in VTE and bleeding in other sites between the two groups(all P>0.05).Multivariate Logistic regression analysis showed that compared with group B,the risk of intracerebral hemorrhage(OR=4.715,95%CI 1.316-16.899,P<0.05)and the risk of death(OR=3.101,95%CI 1.124-8.551,P<0.05)was increased in group A.Conclusions It may be a good time to start prophylactic anticoagulation on the 6th to 7th day post-injury in the patients with high-risk TBI for a better prognosis.