院前使用血凝酶或氨甲环酸对颅脑损伤患者止血效果及预后影响的研究

目的： 探讨院前使用血凝酶或氨甲环酸对颅脑损伤患者止血效果及预后的影响。方法： 选择2016年1月至2019年6月期间本院神经外科住院部收治的颅脑损伤患者124例，采用随机数字表法将患者分为血凝酶组和氨甲环酸组，各62例。血凝酶组院前使用血凝酶进行止血治疗；氨甲环酸组院前使用氨甲环酸进行止血治疗。结果： 血凝酶组平均出血量明显少于氨甲环酸组，治疗前，两组Hb水平比较差异无统计学意义（P>0.05），治疗后，两组Hb水平较治疗前明显降低，P<0.05；血凝酶组Hb水平较氨甲环酸组明显增高，P<0.05。治疗前，两组HCT、Fib、APTT、PT、PAR水平比较差异无统计学意义（P>0.05），治疗后，两组HCT、PAR水平较治疗前明显降低，P<0.05，而两组治疗前后Fib、APTT、PT水平比较差异无统计学意义（P>0.05）。治疗后，血凝酶组HCT、PAR水平较氨甲环酸组明显增高，P<0.05，两组Fib、APTT、PT水平比较差异无统计学意义（P>0.05）。血凝酶组再出血率、预后不良率为1.61%、22.58%，明显低于氨甲环酸的11.29%、40.32%，P<0.05。两组药物不良反应发生率比较差异无统计学意义（P>0.05）。结论： 与院前使用氨甲环酸比较，血凝酶对颅脑损伤患者止血效果更满意，有利于更明显降低再出血风险，改善预后状况，且不增加血栓性疾病的发生风险，值得临床推广应用。

Effects of Prehospital Use of Hemagglutinase or Tranexamic Acid on Hemostasis and Prognosis for Patients with Craniocerebral Injury

Objective: To investigate the effects of prehospital use of hemagglutinase and tranexamic acid on hemostasis and prognosis for patients with craniocerebral injury. Methods: One hundred and twenty-four patients with craniocerebral injury admitted to neurosurgery inpatient department of our hospital from January, 2016 to June, 2019 were selected, and the patients were equally divided into hemagglutinase group and tranexamic acid group by random number table method. Hemagglutinase was prehospitally used in hemagglutinase group for hemostatic treatment. Tranexamic acid was prehospitally used in tranexamic acid group for hemostatic treatment. Results: The average blood loss in hemagglutinase group was significantly lower than that in tranexamic acid group. Before the treatment, the difference in Hb level between the two groups had no statistical significance (P>0.05). After the treatment, Hb level in the two groups were significantly lowered (P<0.05), and Hb level in hemagglutinase group was significantly higher than that in tranexamic acid group (P<0.05). Before the treatment, there was no significant difference in HCT, Fib, APTT, PT and PAR levels between the two groups (P>0.05). After the treatment, HCT and PAR levels in the two groups were significantly lowered (P<0.05), while there was no significant difference in Fib, APTT and PT levels of the two groups between pretherapy and posttherapy(P>0.05). After the treatment, HCT and PAR levels in hemagglutinase group were significantly higher than those in tranexamic acid group (P<0.05), and the difference in Fib, APTT and PT levels between the two groups had no statistical significance (P>0.05). Hemorrhage rate and poor prognosis rate in hemagglutinase group were 1.61% and 22.58%, respectively, which were significantly lower than those in tranexamic acid group of 11.29% and 40.32% (P<0.05). The difference in adverse drug reaction rate between the two groups had no statistical significance (P>0.05). Conclusion: Compared with the prehospital use of tranexamic acid, hemagglutinase showed a more satisfying hemostatic effect for patients with craniocerebral injury, significantly reduced rebleeding risks, improved prognosis, and did not increase risk of thrombotic disease, suggesting that hemagglutinase was worthy of clinical application.