凝血指标对急性颅脑外伤预后的判断价值

目的探讨急性颅脑外伤病人凝血功能异常对病情严重程度和预后的判断价值。方法系统测定119例急性颅脑损伤病人入住ICU6h内的血浆凝血酶原时间（PT）、活化部分凝血激酶时间（AFFr）、D-二聚体（D—Dimer）、INR（凝血酶原时间国际正常化比值）、FBG（纤维蛋白酶原）、TT（凝血酶时间）、PLT（血小板）。结果PT、APTT、INR、FBG及D—Dimer异常在各型急性颅脑损伤组间差异有统计学意义（P〈0．01），此外，重度损伤组INR、D—D明显高于其他组；预后不良组与预后良好组相比，PT、AFFT、INR、DD水平明显增高，差异均有统计学意义（P〈0．01），TT、FBG、PLT则未显示出差异（P〉0．05）；PT、APTT及D—Dimer异常与急性颅脑损伤病人预后存在显著的正相关（P〈0．01）。结论急性颅脑损伤病人凝血功能异常较为常见，其中PT、APTT、INR、D—Dimer异常对病情严重程度及预后有重要的判断价值。

Predicted the outcome of acute head injury by coagulation index

Objective To investigate the changes of coagulation functions in the patients with acute head injury and study the value in estimating the severity and prognosis. Methods 119 patients were divided into three groups according to the disease severity of acute brain injury, and the levels of PT, APTT, INR, FBG, TT, Ph and D - dimer of patients within 6h after their admission were detected according to GCS and GOS, and compared the levels among the three groups as well as the healthy group. Results There were significant differences of PT, AVIT, INR, FBG and D - dimer among three groups （ P 〈 0.01 ）, and the INR, D - dimer in severe injury groups significantly surpass other groups; the levels of PT, APTT, INR and D -dimer were significantly increased in the poor prognosis group than those in the favorable group（P 〈0.01 ）, while the level of the TT, FBG and PLT did not show the differences between two group. The changes of PT, APTT and D - dimer were correlated well with the prognosis of disease （P 〈0.01 ）. Conclusion There are the dysfunctions of coagulation in the patients with acute head injury, and the changes of PT, INR, APTT, D - dimer can be used to evaluate the severity and prognosis of acute head injury.