早期输注新鲜冰冻血浆对外伤性硬膜下血肿患者术后延迟性颅内血肿的影响

目的评价硬脑膜开放前早期输注新鲜冰冻血浆对颅脑损伤后硬膜下血肿患者术后延迟性颅内血肿（delayed traumatic intracranial hematoma,DTIH）发生率的影响。 方法197例重度颅脑损伤患者根据是否发生术后DTIH分为DTIH组和非术后延迟性颅内血肿（non-delayed traumatic intracranial hematoma,NDTIH）组。收集两组患者人口统计学特征（性别、年龄、体重指数）、生命体征（术前平均动脉压、心率）、初始损伤评分、液体输注种类和输注量、血制品输注种类和输注量、新鲜冰冻血浆输注时机及实验室检查等指标，记录术后30 d内的DTIH及死亡情况，将组间比较差异有统计学意义的因素进行二元逻辑回归分析，筛选增加术后DTIH发生的危险因素。 结果32例患者发生术后DTIH，发生率为16.2%。与NDTIH组比较，DTIH组患者的格拉斯哥昏迷评分显著降低，血肿量明显增加，早期输注新鲜冰冻血浆的比例显著增高，差异有统计学意义（P＜0.05）。二元回归分析结果显示，格拉斯哥昏迷评分（OR=4.23,95%CI=1.62~8.72,P＜0.001）、血肿量≥100 mL（OR=5.39,95%CI=1.75~9.38,P＜0.001）以及早期输注新鲜冰冻血浆（OR=1.54,95%CI=1.27~4.29,P=0.016）是术后DTIH发生的危险因素。 结论颅脑损伤后硬膜下血肿患者术后DTIH的发生可能与早期输注新鲜冰冻血浆相关。

Effect of early fresh frozen plasma transfusion therapy on delayed traumatic intracranial hematoma after traumatic subdural hematoma

ObjectiveTo investigate the effects of early fresh frozen plasma transfusion before opening endocranium on incidence of delayed traumatic intracranial hematoma(DTIH) in patients with subdural hematoma after trauma brain injury.MethodsAccording to occurrence of DTIH after surgery, 197 of patients with severe trauma brain injury(TBI) were divided into DTIH group or non-DTIH(NDTIH) group. The patients′ demographics(gender, age, body mass index), vital signs(pre-operative mean arterial pressure, heart rate), initial injury severity(ISS), peri-operative transfusion(type, volume), blood product(type, volume), transfusion time of fresh frozen plasma, laboratory tests, DTIH and mortality within 30 days post-TBI were collected. To account risk factors of DTIH, the significant statistic factors between two groups in the univariate analysis were involved in a bivariate logistic regression.ResultsThere were 32 patients developing new DTIH after surgery. The incidence of new DTIH after surgery was 16.2%. Compared with NDTIH group, the patients in DTIH group showed lower GCS, more hematoma volume, and higher ratio of early fresh frozen plasma transfusion(P＜0.05). In a bivariate logistic regression model, GCS(OR=4.23, 95%CI=1.62-8.72, P＜0.001), hematoma volume ≥100 mL(OR=5.39, 95%CI=1.75-9.38, P＜0.001), and early fresh frozen plasma transfusion(OR=1.54, 95%CI=1.27-4.29, P=0.016) were correlated with new DITH after surgery.ConclusionIncreased incidence of DTIH in patients with subdural hematoma after traumatic brain injury might be associated with early fresh frozen plasma transfusion.