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目的:探讨急性颅脑创伤患者伤后早期凝血和纤溶变化以及与病情危重度GCS及与预后的关系。方法:对528例急性颅脑创伤患者进行前瞻性研究,以同期健康体检者257例作为对照。检测伤后早期(6 h内)血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、凝血酶时间(TT)、D-二聚体(D-D)、血小板(PLT)的含量改变,结合临床格拉斯哥昏迷评分(GCS)分型及格拉斯哥预后评分(GOS)预后分级进行统计学分析。结果:(1)本组患者早期出现凝血-纤溶指标异常的百分比为80.49%(425/528),其中不同凝血-纤溶指标根据异常的百分比由高到低依次为D-D>PT>Fg>APTT>PLT>TT。(2)急性颅脑创伤患者PT、D-D与对照组比较均有统计学差异(P<0.05),且随着颅脑创伤伤情加重PT、D-D含量明显升高;Fg含量在重型和中型患者组与对照组比较差异有统计学意义(P<0.05),而中型与轻型患者组比较、轻型患者组与对照组比较均无统计学差异。APTT、TT含量只有重型患者组与各组比较差异有统计学意义(P<0.05),而中型、轻型患者及对照组之间比较均无统计学差异。PLT在各颅脑创伤组及对照组之间均无统计学差异。(3)GOS 1分组、2~3分组较GOS 4~5分组早期PT、D-D均有明显升高,Fg明显下降(P<0.05)。结论:急性颅脑创伤患者早期存在凝血-纤溶功能异常,PT、D-D、Fg是比较敏感的指标,有助于临床早期判断伤情及预后。
Objective: To investigate the changes of coagulation and fibrinolysis in patients with acute traumatic brain injury (SCI) after traumatic injury and their relationship with the severity of GCS and prognosis. Methods: 528 patients with acute traumatic brain injury were prospectively studied, with 257 healthy subjects as control. The plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), thrombin time (TT), D-dimer , Platelet (PLT) levels were analyzed. Statistical analysis was performed with clinical Glasgow Coma Scale (GCS) classification and Glasgow Outcome Scale (GOS) prognostic grade. Results: (1) The percentage of abnormal coagulation-fibrinolysis in early stage of this group was 80.49% (425/528). Among them, the percentage of abnormal coagulation-fibrinolysis was DD> PT> Fg> APTT> PLT> TT. (2) The PT and DD of patients with acute traumatic brain injury were significantly different from those of the control group (P <0.05), and the contents of PT and DD were significantly increased with the severity of traumatic brain injury. The levels of Fg in severe and medium-sized patients There was significant difference between the control group and the control group (P <0.05). However, there was no significant difference between the control group and the control group in the medium and light groups. APTT, TT content only heavy group of patients with the difference was statistically significant (P <0.05), but no significant difference between the medium and light patients and the control group. There was no significant difference in PLT between the traumatic brain injury group and the control group. (3) The levels of PT and D-D in GOS 1 group and 2 ~ 3 group were significantly higher than those in GOS 4 ~ 5 group, Fg was significantly decreased (P <0.05). Conclusion: There is abnormal coagulation-fibrinolytic function in patients with acute traumatic brain injury in the early stage. PT, D-D and Fg are more sensitive indicators, which can be helpful to early judgment of the injury and prognosis.