颅脑损伤后早期凝血-纤溶功能异常与进展性颅内出血关系的临床研究

目的研究急性颅脑损伤后早期凝血-纤溶功能的变化与进展性颅内出血（PIH）的关系。方法对498例急性颅脑损伤患者进行前瞻性研究,检测伤后早期血浆凝血酶原时间（PT）、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）及血小板（PLT）的含量改变。同时,通过比较颅脑损伤患者连续头颅CT的表现,确定是否发生PIH。分析凝血-纤溶指标异常者PIH的发生率及PIH与非PIH患者凝血-纤溶指标含量的差异。结果在纳入研究的498例患者中,139人（27.91%）发生PIH。PT、Fg、TT、PLT、D-D异常者PIH的发生率均明显高于其正常者PIH的发生率（P〈0.05）。其中PIH患者在伤后早期血浆PT、D-D含量比非PIH患者明显升高,而血浆Fg含量显著下降（P〈0.05）。结论急性颅脑损伤早期血浆PT、D-D、Fg含量的变化,可作为PIH发生的预测因素,对凝血-纤溶功能异常者,应早期连续复查头颅CT,以使PIH患者能及时得到诊治。

Relationship between Abnormal Blood Coagulation-Fibrinolysis and Progressive Intracvanial Hemorrhage in Patients with Traumatic Brain Injury

Objective To investigate the relationship between the changes in blood coagulation-fibrinolysis and progressive intracranial hemorrhage （PIH） in the patients with traumatic brain injury （TBI）. Methods The plasma prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fg）, thrombin time （TT）, platelet （PLT） and D-dimer （D-D） were determined early after TBI in 498 patients with TBI. Whether PIH occurred was observed by the continuous head CT scans. The relationship between blood coagulation-fibrinolysis and incidence of PIH was analyzed. Results Of 498 patients with TBI, 139 （27.91%） suffered from PIH and 359 did not. The incidences of PIH were significantly higher in the patients with abnormal PT, Fg, TT, PLT and D-D were significantly higher respectively than those in the patients with normal PT, Fg, TT, PLT and D-D （P〈0.05 or 0.01）. The plasma levels of PT, D-D in the patients with PIH were significantly higher than those in the patients without PIH （P〈0.05）. The plasma level of Fg was significantly lower in the patients with PIH than that in the patients without PIH （P〈0.05）. Conclusions The abnormity of plasma PT, Fg, D-D early after the injury may serve as indicator of PIH in the patients with TBI. The continuous head CT scanning should be performed in order to diagnose and treat PIH in time in the patients with abnormal blood coagulation-fibrinolysis.