重型颅脑损伤后凝血功能变化的研究

目的研究重型颅脑损伤后凝血功能的变化及临床意义。方法对本院2005年3月至2006年2月收治的26例重型单纯性颅脑损伤患者（GCS≤8分）进行前瞻性研究，监测其入院当时、入院第2天、第3天及第7天的部分凝血活酶时间（APTT），凝血酶原时间（PT），纤维蛋白原（FIB）及凝血时间（TT）的变化。并检测14例单纯头部外伤患者在入院时的APTT、PT、FIB和TT值。结果APTT在入院3天明显升高。1周后仍未达到正常（P〈0．05）；PT在入院当天即升高（P〈0．05），1周左右逐步恢复正常；FIB在入院当天即升高，第3天下降（P〈0．05），1周左右逐步恢复正常。有3例按照DIC诊断标准诊断为DIC，结果在观察期间均死亡。结论重型颅脑损伤后可发生凝血功能异常，且外凝性凝血途径的启动早于内源性凝血途径。伤后早期即可发生高凝状态，至第3天左右向低凝状态转变，1周左右恢复正常。

Coagulation changes after severe head traumas

Objective To study coagulation changes and clinical characteristics after severe head traumas. Methods The blood coagulable data of 26 patients with severe head traumas were detected. The data include Activated partial thromboplastin time(APTT), prothrombin time(PT), fibrinogen(FIB) and thrombin time(TT) at 1st, 2nd, 3rd, 7th day after traumas, same measurements were done in 14 normal control patients at 1st day after traumas. Results APTT increased at 3rd day after traumas and didnot reach normal level at 7th day. (P<0.05)PT increased at 1st day after traumas and reached normal level at 7th day.(P<0.05)FIB increased at 1st day after traumas and began to decrease at 3rd day, FIB began to reach normal level at 7th day. (P<0.05) Conclusions severe head traumas can cause coagulation abnormalitics. Extrinstic coagulation pathway reached peak earlier than intrinsic pathway. Patients with severe head traumas had hypercoagulable status in intial time after traumas, and began to decrease at 3rd day, then reached normal status at 7th day.