摘要
目的探讨创伤性颅脑损伤术后凝血功能障碍的危险因素及与疾病严重程度和肝功能的关系。方法回顾性分析2016年5月—2019年4月河南科技大学第一附属医院重症医学外科收治的创伤性颅脑损伤患者252例的临床资料,男性151例,女性101例;年龄29~66岁,平均44.2岁。根据术后是否发生凝血功能障碍分为凝血障碍组(发生凝血功能异常,n=62)和凝血正常组(未发生凝血功能异常,n=190)。患者入院时受伤严重程度按照GCS分类,GCS 3~8分为重型颅脑损伤组(n=36),GCS 9~12分为中型颅脑损伤组(n=76),12~15分为轻型颅脑损伤组(n=140)。经统计学分析筛选凝血功能障碍的相关危险因素,分析不同疾病严重程度患者各项凝血指标的差异及凝血障碍组和凝血正常组患者各项肝功能指标的差异。结果发生凝血功能异常62例,发生率为24.60%。患者年龄(95%CI1.012~4.183)、入院时GCS低评分(95%CI1.185~3.384)、头部AIS高评分(95%CI1.213~5.101)及头颅CT复查出现血肿增大(95%CI1.102~3.496)与凝血功能异常的发生呈正相关(P<0.05),是凝血功能异常的危险性因素(OR>1)。随着疾病严重程度的增加,创伤性颅脑损伤患者血小板计数(PLT)降低,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)延长,D-二聚体(DD)升高;轻度组、中度组和重度组三组患者的凝血指标PLT、PT、APTT、DD差异有统计学意义(P<0.05)。凝血障碍组血清丙氨酸氨基转移酶(ALT)、血清天门冬氨酸氨基转移酶(AST)、血清总胆红素(TBIL)、血清碱性磷酸酶(ALP)指标异常发生率分别为62.90%、53.23%、54.84%、45.16%,均高于凝血正常组的39.47%、32.63%、34.21%、27.37%(P<0.05)。结论单纯颅脑损伤患者年龄、头部AIS评分、入院时GCS评分及头颅CT复查出现血肿增大是导致患者凝血功能异常的危险因素,术后凝血功能障碍与疾病严重程度及肝功能异常密切相关。
Objective To explore the risk factors of coagulation dysfunction after traumatic brain injury and its relationship with the severity of the disease and liver function.Methods The clinical data of 252 patients with traumatic brain injury admitted to our hospital from May 2016 to Apr.2019 were retrospectively analyzed.There were 151 males and 101 females,with an average age of 44.2 years(29-66 years).According to whether coagulation dysfunction occurred,they were divided into two groups:coagulation dysfunction group(coagulation dysfunction occurred,n=62)and normal coagulation group(no coagulation dysfunction,n=190).The severity of injury at admission was classified according to GCS.GCS 3-8 was divided into severe craniocerebral injury group(n=36),9-12 into moderate craniocerebral injury group(n=76),and 12-15 into mild craniocerebral injury group(n=140).The related risk factors of coagulation dysfunction were screened by statistical analysis,and the differences of coagulation indexes among patients with different disease severity were analyzed.The differences of liver function indexes between patients with coagulation dysfunction and patients with coagulation dysfunction were analyzed.Results In this study,62 cases of coagulopathy occurred,and the incidence rate was 24.60%.Age(95%CI:1.01-4.183),low GCS score at admission(95%CI:1.185-3.384),high AIS score at head(95%CI:1.213-5.101)and increased hematoma on CT scan(95%CI:1.102-3.496)were positively correlated with coagulation dysfunction(P<0.05),and were risk factors for coagulation dysfunction(OR>1).With the increase of disease severity,PLT decreased,PT and APTT prolonged and DD increased in patients with traumatic brain injury.There were significant differences in coagulation indexes PLT,PT,APTT and DD among mild trauma group,moderate trauma group and severe trauma group(P<0.05).The abnormal rates of ALT,AST,TBIL and ALP in coagulation dysfunction group were 62.90%,53.23%,54.84%and 45.16%,respectively,which were higher than those in normal coagulation group(39.47%,3
作者
李兵
乔鹏
武宏杰
LI Bing;QIAO Peng;WU Hong-jie(Department of Intensive Care,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China;Department of Neurosurgery,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China)
出处
《创伤外科杂志》
2020年第6期447-450,共4页
Journal of Traumatic Surgery
关键词
颅脑损伤
凝血功能
肝功能
危险因素
craniocerebral injury
coagulation dysfunction
liver function
risk factors
