外伤性脑梗死与凝血功能障碍的关系及其对中、重度颅脑损伤患者预后的影响

目的探讨早期（伤后1周）外伤性脑梗死与凝血功能异常的关系,及其对中、重度颅脑损伤患者预后的影响。方法回顾性分析我科收治的218例中、重度颅脑损伤患者的临床资料,记录患者凝血功能各项指标以及入院时GCS评分、弥漫性血管内凝血（DIC）评分;伤后3个月采用GOS评分评估患者预后;使用Logistic回归分析颅脑损伤患者继发外伤性脑梗死的影响因素及凝血功能异常和外伤性脑梗死对患者预后的影响。结果本组患者中27例伤后1周出现外伤性脑梗死;伤后3个月,预后良好（GOS评分4~5分）178例,预后不良（GOS评分1~3分）40例。Logistic回归分析显示血小板计数〈100×109/L、凝血酶原时间延长超过3 s、D-二聚体〉0.4 mg/L、DIC评分≥5分是中、重度颅脑损伤患者继发早期PTCI的独立预测因子（P〈0.05）;同时,它们也是中、重度颅脑损伤患者预后不良的独立预测指标（P〈0.05）。结论监测中重度颅脑外伤患者的凝血功能对于指导治疗及判断预后是帮助。

Clinical analysis of relationship of hemocoagulation disorders with posttraumatic cerebral infarction and prognoses in patients with traumatic brain injury

Objective To assess the relationship of the hemocoagulation disorders with posttraumatic cerebral infarction （PTCI） and prognoses in the patients with moderate or severe traumatic brain injury （TBI）. Methods The clinical data of 218 patients with moderate or severe TBI were analyzed retrospectively. PTCI occurred within 1 week after TBI in 27 of the 218 patients. The relationship of hemocoagulation disorders with the development of PTCI and prognoses in the patients with TBI patients were analyzed by univariate and Logistic regression analyses. Results Univariate analysis revealed that the risk factors of PTCI included low GCS, decrease in platelet （PLT）, prolongated prothrombin time （PT）, low level of fibrinogen （FIB）, elevated D-dimer level and high disseminated intravascular coagulation （DIC） scale （P〈0.05）, and the risk factors of the poor prognosis included low GCS on admission, prolongated PT, abnormal activated partial thromboplastin time （APTF） and FIB, high D-dimer level and DIC scale and the presence of PTCI in the patients with moderate or severe TBL The multivar/ate analysis revealed that the independent risk factors of PTCI included decrease in PLT, abnormal PT, and high D-dimer level and DIC scale （P〈0.05）, and the independent risk factors of poor prognosis included low GCS on admission, prolongated PT, abnormal FIB, high D-dimer level and DIC scale, and the presence of PTCI in the patients with TBI. Conclusion Monitoring the hemocoagulation function is helpful to predicting the prognoses in the patients with moderate or severe TBI.