颅脑外伤后凝血及抗凝因素与其预后的临床研究

目的检测脑外伤患者的凝血及纤溶因素,分析其脑外伤后的变化及与伤情和预后的关系,探讨其临床意义。方法选取80名脑外伤患者,测定入院时、伤后第4天及第8天血浆组织因子(TF)和D-二聚体(D-D)水平,与正常对照组比较,再按格拉斯哥昏迷评分(GCS)及预后进行组间比较。结果脑外伤患者的TF、D-D水平于入院时较对照组显著升高(P<0.01),此后逐渐下降,第4天时仍高于对照组(P<0.01),第8天的时候接近正常范围。GCS≤8分组的TF、D-D水平持续高于GCS>8分组和对照组(P<0.01);GCS>8组伤后8天时的TF水平基本降为正常值,而GCS≤8分组TF、D-D水平持续高于对照组和GCS>8分组(P<0.01)。预后不良和死亡组同样高于预后良好组(P<0.01)。结论脑外伤患者早期存在高凝和继发性纤溶功能亢进,早期检测凝血纤溶功能对脑外伤伤情评估和预后具有重要的临床意义。

Coagulation and Anticoagulation Factors in the Prognosis of Patients After Traumatic Brain Injury

Objective To detect coagulation and fibrinolysis factors of patients with traumatic brain injury,to analyze their changes after injury,and the association with the degree of injury and prognosis,and explore clinical significance.Methods We selected 80 patients with traumatic brain injury,measured their plasma tissue factor(TF) and D-dimer(D-D) levels on admission,the fourth and eighth day after injury,compared among groups after dividing them into groups according Glasgow coma scale(GCS) and prognosis.Results TF and D-D levels of traumatic brain injury patients were significantly higher than those of the control group at admission(P<0.01),then decreased gradually,while still higher on the fourth day(P<0.01) and closed to the normal range on the eighth day.TF and D-D levels of GCS≤8 group were consistently higher than those of GCS>8 group and the control group(P<0.01).TF levels of GCS>8 group were almost closed to normal range on the eighth day,while TF and D-D levels of GCS≤8 group sustained significantly higher than GCS>8 group(P<0.01).Similarly,poor prognosis group and death group were higher than good prognosis group(P<0.01).Conclusion Patients with traumatic brain injury early are at presence of hypercoagulability and secondary fibrinolysis.Early detection of blood coagulation and fibrinolysis indicators is of importance for assessment and prognosis of injury.