重型颅脑损伤急性期血浆纤维蛋白原和D-二聚体动态改变的临床意义

目的 观察重型颅脑损伤患者不同时间、不同部位血标本中血浆纤维蛋白原(Fbg)和D-二聚体(D-dimer)的变化及其与预后的关系.方法 本组共33例单纯性颅脑损伤患者,在颅脑损伤后4h、8 h、16h、24h、36h、48h分别检测患者动脉、外周静脉、颈静脉三处血标本中Fbg和D-dimer水平并进行统计学分析.结果 颅脑损伤后4 h时Fbg值高于正常水平,此后出现降低,16h降至低于正常值.24h后Fbg水平出现回升.但颈静脉血标本比外周静脉和动脉血标本回升慢,差异有统计学意义(P<0.05);D-dimer伤后4 h即出现升高,随着时间推移逐渐下降.在48 h内仍保持高于正常水平.预后不良与预后良好患者在相同时间点的Fbg和D-dimer值比较,差异有统计学意义(P<0.05).结论 颅脑损伤后急性期出现凝血功能异常,表现为Fbg含量的降低,其降解产物D-dimer含量的显著升高,反映了脑内出现高凝状态和继发性纤溶亢进.提示凝血功能的变化可作为评价患者伤情和影响患者预后的一个因素.

Clinical significances of plasma Fbg and D-dimer tn acute stage for the patients with severe head injury

Objective To observe the dynamic change of plasma fibrinogen (Fbg) and D-dimer within 48 h in blood samples from the patients with simple severe head injury, and explore the correlation of plasma Fbg and D-dimer levels with the patient's prognosis. Methods In 33 patients with simplese vere head injury, we obtained the blood samples from the artery (A), vein (V) and jugular vein (JV) at different time points (post injury 4, 8, 16, 24, 36 and 48 h) and detected the plasma Fbg and D-dimer levels, respectively. The data were statistically analyzed by SPSS ! 1.5. Results Plasma Fbg was higher than the normal value at 4 h after head injury, and then it was decreased obviously and lower than the normal value at 16 h, and since 24 h it was increased to the normal value. The rising of Fbg was slower in jugular vein than in artery and peripheral vein after 24 h (P<0.05). D-dimer was increased at 4 h after injury, and gradually decreased with the time going on, but the level retained over the normal value until 48 h. In the comparison between the patients with bad prognosis and the ones with satisfactory prognosis, the means of plasma Fbg and D-dimer had significant difference at the same time point (P< 0.05). Conclusions Head injury can result in coagulation disorder, which presents Fbg consumption and decrease and its degradation product D-dimer increase obviously. The changes indicate hypercoagulahale state and secondary hyperfibrinolysis after head trauma. The coagulopathy can be an indicator for judging the severity and prognosis of head injury.