重重度颅脑损伤早期凝血-纤溶异常与PIH及预后的相关性

目的:探讨急性重度颅脑损伤患者早期凝血-纤溶功能异常对预测进展性颅内出血(PIH)及评判其预后的价值。方法:急诊检测85例重度单纯性颅脑损伤患者早期(伤后6h内)血浆凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)、凝血酶时间(TT),并动态复查CT确定有无PIH发生,随访1年进行格拉斯哥预后评分(GOS)。分析凝血常规各项指标的变化与病情及预后的关系。结果:重度颅脑损伤早期即有凝血功能异常,APTT延长、PT延长、Fbg下降都与PIH发生及预后密切相关(P0.05),而TT改变与PIH发生及预后无统计学关系(P0.05)。结论:颅脑损伤早期PT、APTT、Fbg变化可作为预测PIH发生的指标之一,对早期APTT、PT延长而Fbg下降者更应积极连续复查头颅CT,以期更加及时诊断PIH的发生。

Correlation between Coagulation dysfunction and Progressive Intracranial Hemorrhage and Prognosis in Patients with Severe traumatic brain injury

Objective： To investigate the relationship between early change of coagulation-fibrinolysis function with PIH and prognosis in patients with severe traumatic brain injury. Methods： The prothrombin time （PT）, acti- vated partial thromboplastin time （AFFF）, fibrinogen （Fbg）, thrombin time（TI） were determined early after severe traumatic brain injury in 85 patients. Continuous： head CT scans were done to observed the Progressive intracranial hemorrhage （PIH）.The relationship between the change of index and the PIH and prognosis was analyzed. The prognosis was assessed by the Glasgow Outcome Scale （GOS）. Results The coagulation-fibrirolysis function changed early in brain traumatic patients. PT, AFFF levels were higher and Fbg level was lower, and they were sig- nificant relationship between them with the PIH and prognosis （P〈0.05）, while the change of TT didn＇t correlated well （P〉 0.05）. Conclusion Early blood coagulation dysfunction is common in patients with severe traumatic brain. The changes of PT, AFFF and Fbg can be used to evaluate the PIH and prognosis of severe traumatic brain injury.