摘要
目的探讨凝血功能异常与颅脑外伤患者伤情严重程度及预后的关系。方法回顾性分析198例颅脑外伤患者的临床资料。检测患者伤后凝血功能的各项指标,包括血小板计数、PT、APTT、FIB、D-二聚体含量和DIC评分,进行格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分。伤后3个月时进行格拉斯哥预后量表(Glasgow outcome scale,GOS)评分。对凝血功能与患者伤情严重程度的关系,以及对预后影响进行统计学分析。结果颅脑外伤重型组的PT较轻型、中型组显著延长,D-二聚体含量及DIC评分明显升高(均P<0.05)。与未发生迟发性颅内血肿患者(149例)相比,出现迟发性颅内血肿患者(49例)的PT、APTT明显延长,血小板数减少,D-二聚体含量和DIC评分升高,差异均有统计学意义(P<0.05~0.01)。多因素Logistic回归分析显示,入院时GCS评分≤5分、出现迟发性颅内血肿、PT延长、D-二聚体含量>2 mg/L及DIC评分≥5分是预后不良的独立预测指标。结论凝血功能异常与颅脑外伤患者的损伤程度、预后有显著关系;监测凝血功能各项指标对患者的伤情判断、预后转归和治疗有指导作用。
Objective To assess the relationship between hemocoagulation disorders and injury severity and to evaluate their influence on outcome among brain trauma patients. Methods 198 brain trauma cases were analyzed,hemocoagulation parameters including platelet count（ PLT）,prothrombin time（ PT）,activated partial thromboplastin time（ APTT）,fibrinogen（ FIB）,D-dimer,admission GCS score,DIC score and GOS score after three months were recorded. To analysis of the relationship between hemocoagulation disorder and the injury severity of the patients using the statistical method,and the influence on prognosis of the patients. Results In severe traumatic brain injury patients,compared with mild and moderate traumatic brain injury patients,PT were significantly prolonged,D-dimer and DIC score significantly increased（ P〈0. 05）. In 49 cases comfirmed delayed intracranial hematoma,PT and APTT were prolonged significantly,platelet significantly reduced,D-dimer and DIC score increased significantly（ P〈0. 05-0. 01） compared with the patients without the occurrence of delayed intracranial hematoma. Low admission GCS score（3-5）,the presence of delayed intracranial hematoma,abnomal PT and D-dimer（ 2mg/L）,DIC score≥5 showed an independent predictive effect on poor outcome. Conclusion There is a certain relationship between the hemocoagulation disorder and the injury severity and prognosis in traunatic brain injury patient.
出处
《临床神经外科杂志》
CAS
2017年第2期145-148,共4页
Journal of Clinical Neurosurgery
关键词
颅脑外伤
凝血功能
伤情
预后
traumatic brain injury
hemocoagulation disorders
injury severity
outcome
