脑出血后凝血与纤溶系统紊乱及其对预后的影响

目的：研究脑出血早期凝血与纤溶系统功能障碍，并探讨其与脑出血程度及预后的关系。方法：47例脑出血患者和32例急性单纯性阑尾炎患者于入院6h内行DIC筛选试验与部分凝血活酶时间(APTT)测定，并分别根据Glasgow(GCS)昏迷评分和D—聚体(D—dimer)测定值对脑出血病人进行分组，计算各组的死亡率。结果脑出血组的凝血酶原时间(PT)、凝血酶原时间（TT)、D—dimer及APTTT值明显高于对照组(P＜0.05)；按GCS评分分组，GCS评分越低，D—dimer值越高(P＜0．05)；按D—dimer值分组，D—dimer值越高，死亡率越高(P＜0.05)。结论：脑出血早期存在凝血与纤溶系统紊乱，D—dimer是准确判断脑出血早期病情严重程度及预后的可靠指标。

DISTURBANCES OF BLOOD COAGULATION AND FIBRINOLYSIN A FTER CEREBRAL HEMORRHAGE AND THEIR EFFECT ON PROGNOSIS

Objective:To investigate the disturbances of blood coagulation and fibrinolysin in early stage of cerebral hemorrhage, and evaluate their effect on diagnosis. Methods:Forty-seven patients with cerebral hemorrhage (group A) and 32 patients with acute appendicitis (group B) were measured DIC screen tests and APTT during 6 hours at admission.Patients with cerebral hemorrhage also stratified by the results of Glasgow Coma Scales (GCS) or D-dimer,and mortality rate were evaluated respectively. Results:PT, TT, D-dimer and APTT in group A were significantly higher than those in group B ( P <0.05); there was also a significant correlation between GCS and D-dimer. A significant increase in mortality rate was observed among patients with higher D-dimer. Conclusion:Dysfunction of blood coagulation and fibrinolysin systems may be exist during early stage of cerebral hemorrhage; the level of D-dimer should be a reliable marker for evaluating disease severity and prognosis.