颅脑损伤病人血浆D-二聚体变化的临床意义

目的 探讨颅脑损伤病人血浆D-二聚体变化及其临床意义。方法 回顾性分析2018月5年到2019年5月收治的100例单纯急性颅脑损伤的临床资料。采用免疫比浊法动态检测伤后1、3、5、7、9 d血浆D-二聚体水平。伤后3个月，采用GOS评分评估预后，4~5分为预后良好，1~3分为预后不良。另选取同期健康体检者50例作为对照组。结果 100例中，预后不良28例，预后良好72例。重型颅脑损伤28例中，伤后3个月死亡8例，存活20例。颅脑损伤病人伤后血浆D-二聚体含量先增高，后降低，伤后3 d达高峰。伤后1~9 d，颅脑损伤病人血浆D-二聚体含量明显高于对照组（P<0.05），而且，随颅脑损伤程度加重，血浆D-二聚体含量明显增高（P<0.05）。伤后1~7 d，预后不良组血浆D-二聚体含量明显高于预后良好组（P>0.05），伤后9 d，两组无统计学差异（P>0.05）。28例重型颅脑损伤中，死亡病人伤后1~3 d血浆D-二聚体含量明显高于存活病人（P<0.05）；伤后5~9 d，死亡病人和存活病人血浆D-二聚体含量无统计学差异（P>0.05）。结论 动态监测血浆D-二聚体有助于早期、快速判断颅脑损伤病人伤情及预后

Clinical significance of plasma D-dimer changes in patients with traumatic brain injury

Objective To investigate the clinical value of plasma D-dimer in patients with traumatic brain injury (TBI). Methods The clinical data of 100 patients with TBI who were admitted to our hospital from May 2018 to May 2019 were analyzed retropsectively. In addition, 50 healthy subjects were selected as the control group. The levels of plasma D-dimer were detected by immuno turbidimetry in the patients with TBI 1, 3, 5 ,7, and 9 days after injury. The GOS score was used to evaluate the prognosis 3 months after injury, with good prognosis of 4~5 points and poor prognosis of 1~3 points. Results Of these 100 patients, 28 patients had poor prognoses and 72 had good prognoses. Of 28 patients of with severe TBI, 8 died and 20 survived 3 months after the injury. The level of plasma D-dimer of patients with TBI increased first, then decreased, and reached a peak 3 days after injury. The level of plasma D-dimer was significantly higher in patients with TBI than that in the control group 1, 3, 5 ,7, and 9 days after injury (P<0.05). The level of plasma D-dimer was significantly higher in patients with severe TBI than that in patients with mild and moderate TBI 1, 3, 5 ,7, 9 days after injury (P<0.05). The level of plasma D-dimer was significantly higher in the patients with poor prognosis than that in the patients with good prognosis 1, 3, 5, and 7 days after injury(P<0.05). The level of plasma D-dimer was significantly higher in the death patients than that in the survival patients among the severe TBI patients 1, and 3 days after injury (P<0.05). Conclusion Dynamic monitoring of plasma D-dimer is helpful to early and rapid assessing the injury and prognosis of patients with TBI