颅内血肿开颅血肿清除术后迟发血肿与纤溶改变的临床研究

目的：探讨外伤性颅内血肿开颅血肿清除术后迟发血肿患者的凝血功能改变，及与预后的预测价值。方法：选取我院收治的外伤性颅内血肿开颅血肿清除术患者100例，其中迟发血肿51例，非迟发血肿49例；依据GCS评分，分为轻型组：13～15分58例；中型组：9～12分32例；重型组：3～8分10例，采用酶联免疫吸附双抗体夹心法（ELISA）检测患者凝血活酶时间（APTT）、凝血酶原时间（PT）、D-二聚体（D-D）、凝血酶时间（TT）、血小板（PLT）水平变化，并设同期体检正常者30例为对照组，进行对比分析。结果：颅脑损伤轻、中重型患者PT、APTT、D—D、纤维蛋白降解产物（FDP）水平均较对照组增高，差异具有统计学意义（P〈0．05），PT、APTT、D—D、FDP水平与损伤程度呈正相关；PLT、Fg水平较对照组降低，差异具有统计学意义（P〈0．05），与损伤程度呈负相关。结论：颅内血肿开颅血肿清除术后迟发血肿患者体内存在明显的凝血与纤溶异常，异常程度与颅脑损伤程度密切相关，临床检测凝血与纤溶指标可作为病情评估和预后判断的重要参考指标。

Intracranial hematoma craniotomy hematoma removal surgery delayed hematoma and fibrinolytic changes

Objective. To investigate the changes in coagulation function and prognosis value of de- layed hematoma after craniotomy hematoma removal with traumatic intracranial hematoma. Methods： Se- lected 100 cases of traumatic craniotomy hematoma after removal of intracranial hematomas from January 2011 to January 2012, of which 51 cases were delayed hematoma and 49 cases were nondelayed hematoma. According to GCS score, these cases were divided into mild group： （13-15 points, 58 cases） medium group （9-12 points, 32 cases）, critical group （3-8 points, 10 cases）, using ELISA for detecting the level changes with blood coagulation time （APTT）, prothrombin time （PT）, D dimer （DD）, thrombin time （TT）, platelet （PLT） in patients, and 30 healthy cases were also enrolled as control group. Results： In the mild, medium and critical groups, PT, APTT, D-D, FDP levels were significantly higher than that in the con- trol group （P〈0.05）, PT, APTT, D-D, FPD level were positively correlated with the damage degree; PLT, Fg levels were significantly lower than the control group （P〈0.05）, and negatively correlated with the damage degree. Conclusion： Intracranial hematoma with delayed hematoma after craniotomy hematoma removal can induce obvious abnormal blood coagulation and fibrinolysis, the abnormal degree is closely re- lated to the degree of craniocerebral injury, clinical detection of blood coagulation and fibrinolytic indexes can be used as important reference index for condition evaluation and prognosis judgement.