D-二聚体与进展性颅内出血的相关性研究

目的研究急性颅脑损伤病人早期D-二聚体（D-D）的变化,分析D-D与进展性颅内出血（PIH）的相关性,评估D-D对急性颅脑损伤的病情及预后的价值。方法检查292例急性颅脑损伤患者血浆D-D于颅脑损伤后24 h、3 d、7 d、14 d的变化。对其进行前瞻性研究,分析D-D与PIH、颅脑损伤病情及预后的关系。结果 292例患者中伤后24 h D-D异常发生率64.73%,明显高于伤后7 d、14 d（P〈0.01）,且易发生PIH。病情重者及死亡组D-D异常更显著（P〈0.01）。结论急性颅脑损伤中D-D异常发生率高,血液高凝状态与纤溶亢进并存,纤溶指标升高显著时,伤情严重,PIH发生率高,死亡率高。提示D-D可作为PIH发生的预测因素,对急性颅脑损伤病情评估及预后判断有较高价值。

Relationship between D-Dimer and progressive intracranial hemorrhage in patients with traumatic brain injury

Objective To study the changes of D-Dimer（ D-D） in patients with traumatic brain injury（ TBI）,analyse the relationship between D-D and progressive intracranial hemorrhage（ PIH）and evaluate the predictive value of D-D on the severity and outcome for patients with TBI. Methods D-D were measured in 292 patients with TBI within 24h,3d,7d and 14d. The relationship between D-D and the severity and outcome for patients with TBI was analyzed and studied. Results The frequency of high D-D was 64. 73% within 24h in 292 patients,and higher than 7d,14d（ P 0. 01）. The incidences of PIH were significantly higher with high D-D than those patients with normal D-D（ P 0. 01）. The D-D was more prominent in sever injured groups and died groups.Conclusions The frequency of D-D is very high in TBI,the hypercoagulation and secondary hyperfibrinolysis coexisted in early stage,when the fibrinolysis prominent,trauma is sever,The frequency of PIH and death were high. This suggests that the D-D early after the injury may serve as indicator of PIH in the patients with TBI,and is valuable prognostic makers to the sever level and the prognostic implication in TBI.