急性单发性创伤性颅脑损伤术后凝血功能障碍与肝功能异常的相关性

发布时间：2018-06-01 07:19

本文选题：急性单发性创伤性颅脑损伤 + 凝血功能障碍　；参考：《中国医科大学学报》2016年03期

【摘要】：目的分析急性单发性创伤性颅脑损伤术后凝血功能障碍与肝功能异常的关系。方法回顾性分析我科2012年1月至2014年12月收治的满足入组条件的凝血功能障碍患者51例,按照1∶3配比进行病例对照研究,分析术后凝血功能障碍的发生与肝功能的相关性。结果将配比的凝血功能障碍组和对照组患者按照格拉斯哥昏迷评分(GCS)分为重型颅脑损伤(GCS 3~8分)和轻中型颅脑损伤(GCS 9~15分),结果表明术后凝血功能障碍的发生与创伤性颅脑损伤的严重程度相关(P0.001)。在重型颅脑损伤中,肝功能指标丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)与术后凝血功能障碍呈正相关(P=0.008,OR=4.318,95%CI 1.429~13.053和P=0.036,OR=3.109,95%CI 1.064~9.081),而在轻中型颅脑损伤中ALT和AST与术后凝血功能障碍无明显相关性(P0.05)。其他指标碱性磷酸酶、γ-谷氨酰基转移酶和总胆红素无论在重型还是轻中型颅脑损伤中,均与术后凝血功能障碍无统计学相关性(P0.05)。结论急性单发性创伤性重型颅脑损伤术后凝血功能障碍与肝功能异常密切相关,临床医生不应忽视手术后凝血功能障碍的发生,应在围手术期严密监测肝功能并纠正肝功能异常,防止术后凝血功能障碍的出现,改善患者预后。
[Abstract]:Objective to analyze the relationship between coagulation dysfunction and liver dysfunction after acute traumatic craniocerebral injury. Methods from January 2012 to December 2014, 51 patients with coagulation dysfunction who were admitted to our department from January 2012 to December 2014 were retrospectively analyzed. A case-control study was carried out according to the 1:3 ratio, and the correlation between postoperative coagulation dysfunction and liver function was analyzed. Results according to Glasgow coma score (Glasgow coma score), the patients in the proportion of coagulation dysfunction group and control group were divided into severe craniocerebral injury (GCS 3 ~ 8) and light and moderate craniocerebral injury (GCS 9 ~ 15). The severity of traumatic craniocerebral injury was correlated with P0.001. In severe craniocerebral injury, Liver function indexes, alanine aminotransferase (alt) and aspartate aminotransferase (AST), were positively correlated with postoperative coagulation dysfunction (P < 0. 008) and CI 1. 429 ~ 13. 053 and P0. 036 ORT = 3. 109 / 95CI 1.0649.081respectively. However, there was no significant correlation between ALT and AST in mild and moderate craniocerebral injury and postoperative coagulation dysfunction (P 0. 05). There was no significant correlation between alkaline phosphatase, 纬-glutamyl transferase and total bilirubin in patients with severe or mild craniocerebral injury. There was no significant correlation between ALP, 纬-glutamyl transferase and postoperative coagulation dysfunction (P 0. 05). Conclusion Coagulation dysfunction is closely related to hepatic dysfunction after acute traumatic severe craniocerebral injury. The clinicians should not ignore the occurrence of coagulation dysfunction after operation. The liver function should be closely monitored and corrected during perioperative period to prevent the occurrence of postoperative coagulation dysfunction and to improve the prognosis of the patients.
【作者单位】：中国医科大学附属第一医院神经外科;河北北方学院第一附属医院神经外科;中国医科大学附属盛京医院急诊科;海南医学院附属医院急危重症医学部;
【基金】：教育部留学回国人员科研启动基金(教外司留[2013]1792号) 辽宁省自然科学基金(2015020460,2013021083) 沈阳市科技创新专项基金人口与健康科技攻关专项(F13-220-9-53)
【分类号】：R651.15

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