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| 急性颅脑创伤后早期凝血-纤溶变化的临床意义 |
| 童武松1,徐俊法1,杨文进1,郑平1,李高义1,郭义君1,何斌1,曾劲松1,唐馨芬2,林同顺2 |
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| (1.上海市浦东新区人民医院神经外科,上海 201200;2.上海市浦东新区人民医院检验科,上海 201200) |
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| 摘要: |
| 目的:探讨急性颅脑创伤患者伤后早期凝血和纤溶变化以及与病情危重度GCS及与预后的关系。方法:对528例急性颅脑创伤患者进行前瞻性研究,以同期健康体检者257例作为对照。检测伤后早期(6 h内)血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、凝血酶时间(TT)、D-二聚体(D-D)、血小板(PLT)的含量改变,结合临床格拉斯哥昏迷评分(GCS)分型及格拉斯哥预后评分(GOS)预后分级进行统计学分析。结果:(1) 本组患者早期出现凝血-纤溶指标异常的百分比为80.49%(425/528),其中不同凝血-纤溶指标根据异常的百分比由高到低依次为D-D>PT>Fg> APTT >PLT>TT。(2)急性颅脑创伤患者PT、D-D与对照组比较均有统计学差异(P<0.05),且随着颅脑创伤伤情加重PT、D-D含量明显升高； Fg含量在重型和中型患者组与对照组比较差异有统计学意义(P<0.05),而中型与轻型患者组比较、轻型患者组与对照组比较均无统计学差异。APTT、TT含量只有重型患者组与各组比较差异有统计学意义(P<0.05),而中型、轻型患者及对照组之间比较均无统计学差异。PLT在各颅脑创伤组及对照组之间均无统计学差异。 (3)GOS 1分组、2～3分组较GOS 4～5分组早期PT、D-D均有明显升高,Fg明显下降(P<0.05)。结论:急性颅脑创伤患者早期存在凝血-纤溶功能异常,PT、D-D、Fg是比较敏感的指标,有助于临床早期判断伤情及预后。 |
| 关键词: 颅脑创伤 凝血 纤维蛋白溶解 |
| DOI：10.3724/SP.J.1008.2009.01260 |
| 投稿时间：2009-02-19修订日期：2009-06-12 |
| 基金项目:上海市浦东新区社会发展局卫生科技专项基金(PW2006A-21). |
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| Changes of blood coagulation and fibrinolysis in acute craniocerebral injuries:clinical significance |
| TONG Wu-song1,XU Jun-fa1,YANG Wen-jin1,ZHENG Ping1,LI Gao-yi1,GUO Yi-jun1,HE Bin1,ZENG Jin-song1,TANG Xin-fen2,LIN Tong-shun2 |
| (1.Department of Neurosurgery,People’s Hospital of Pudong New Area,Shanghai 201200,China;2.Department of Laboratory Diagnosis,People’s Hospital of Pudong New Area,Shanghai 201200) |
| Abstract: |
| Objective:To investigate the changes of blood coagulation and fibrinolysis in patients with acute craniocerebral injuries (ACI) and to assess their relationship with patients’ diagnoses and prognoses.Methods: A prospective study was performed using 528 ACI patients and 257 healthy controls taking a physical examination.The prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fg),thrombin time (TT),platelet (PLT),and D-dimer (D-D) were observed within 6 h after injury.Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) were also employed and the statistical analysis was performed.Results: The incidence of abnormal blood coagulation and fibrinolysis in our group was 80.49% (425/528),with the abnormal indicators from high incidence to low were:D-D>PT>Fg> APTT >PLT>TT.(2) The levels of PT and D-D in ACI patients were significantly different from those of the control group (P<0.05);their levels increased with the aggravation of the severity of the injuries.Fg levels in the severe and moderate ACI patients were significantly different from that in the control group (P<0.05); there were no significant differences between the moderate inury group and the slight injuy group or between the slight injury group and the control group.The levels of APTT and TT were significantly different between the severe injury group and other groups(P<0.05).PLT levels were similar in all the groups.(3) Patients of GOS 1 and 2-3 had significantly increased PT,D-D levels and decreased Fg level compared with patients of GOS 4-5.Conclusion: ACI patients have abnormal coaculation and fibrinolysis function early after injury.PT,D-D and Fg are sensitive indices and may be helpful for early prediction of the injuries and prognoses. |
| Key words: craniocerebral trauma coagulation fibrinolysis |
