急性颅脑损伤与凝血功能障碍和进展性出血性损伤的关系：危险因素分析

发布时间：2018-06-25 07:59

本文选题：TBI + 颅内进展性出血　；参考：《华中科技大学》2013年博士论文

【摘要】：第一部分：急性期颅脑损伤凝血功能变化与进展性出血的关系目的：探讨急性颅脑损伤患者凝血功能的变化及其临床意义,研究其与颅脑损伤严重程度(GCS)及患者预后(GOS)之间的关系,并观察PT、APTT、FG、TT、INR、 PLT与进展性颅内出血(PHI)的关系。方法：(1)将154例急性颅脑损伤患者分为轻、中、重型3组,测定病人入院24h内的血浆活化部分凝血活酶时间(APTT)、纤维蛋白原(FG)、凝血酶原时间(PT)、凝血酶时间(TT)、国际敏感度(INR)、血小板(PLT)进行检测,并与48例健康对照组比较,(2)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(PHI)。(3)治疗6个月后随访分为GOS4～5分(预后良好good prognosis)和1-3分(预后不良poor prognosis),进行比较各组之间凝血功能的差异,观察颅脑损伤凝血功能变化与预后的关系。数据采集用SPSS13.0进行统计处理及分析。结果：轻、中、重型颅脑损伤组伤后APTT、PT、INR水平明显高于对照组,而FG水平明显低于对照组(P0.05)；损伤程度越重APTT、PT、INR水平越高,FG水平越低(P0.05)。进展性颅内出血组伤后PT、INR含量比无进展性颅内出血组明显升高(P0.05),而FG含量比无进展性颅内出血组显著下降(P0.05)。预后不良组FG、INR和PLT异常较预后良好组明显差别,差异均有统计学.(P0.05)。结论：急性颅脑损伤后存在凝血功能异常,且与颅脑损伤程度密切相关,可为判断急性颅脑损伤预后参考指标。早期血浆PT、FG、INR,含量的变化可作为颅脑损伤进展性颅内出血发生的预测因素。第二部分：颅脑损伤后颅内进展性出血的危险因素目的：探讨急性颅脑损伤后颅内进展性出血的危险因素。方法：分析我院神经外科2011年2月至2012年8月间收治的154例前瞻闭合性颅脑损伤的临床资料,根据颅内出血进展情况分为出血组(n=62)和非出血组(n=92)。进行比较两组患者的不同性别、年龄、格拉斯哥昏迷评分(GCS)、受伤至首次CT检查时间(HCT1)、损伤类型和部位、首次CT血肿量等对进展性出血损伤(PHI)发生的影响,探讨其发生的危险因素。采用Logistic回归分析颅内进展性出血的危险因素。结果：本组62例(40.2%)发生进展性出血。本研究154例病人中,105男性患者中有44出现进展性出血,49个女性患者中有18个出现进展性出血,两组之间无明显差别；年龄最小为18岁,最大为72岁,进展性出血组平均年龄高于非进展性出血组(P0.05)；123名病人是在受伤后2小时内入院行CT扫描,受伤到入院时间短的病人PHI发生率高(P0.05)；患者GCS评分较低组进展性出血高于评分较高的GCS组,两组之间有显著性差别(P0.05)。伤后首次CT表现为硬膜下血肿和脑内血肿会增加PHI的发生率(P0.05)。应用多因素Logistic回归分析显示,进展性出血组与非进展性出血组在伤后,年龄,受伤到首次CT扫描,伤后早期CT表现为脑挫裂伤、颅骨骨折、蛛网膜下腔出血,硬膜外血肿发生的均为危险因素(P0.01)。结论：多种因素可以共同参与颅脑损伤后颅内进展性出血损伤。大年龄患者、受伤到首次CT检查的时间短,早期CT表现为颅骨骨折、脑挫裂伤、蛛网膜下腔出血,硬膜外血肿者,应及时复查头脑CT,了解病人情况的变化,使患者得到及时治疗和处理,改善TBI患者的成功率。
[Abstract]:Part one: relationship between coagulation function changes and progressive bleeding in patients with acute craniocerebral injury
Objective: To investigate the changes in coagulation function and its clinical significance in patients with acute craniocerebral injury, to study the relationship with the severity of craniocerebral injury (GCS) and the prognosis of patients (GOS), and to observe the relationship between PT, APTT, FG, TT, INR, PLT and progressive intracranial hemorrhage (PHI).
Methods: (1) 154 patients with acute craniocerebral injury were divided into 3 groups of light, medium and heavy. The plasma activated partial thromboplastin time (APTT), fibrinogen (FG), prothrombin time (PT), thrombin time (TT), international sensitivity (INR) and platelet (PLT) were measured in the patients' hospitalized 24h, and compared with 48 healthy controls, (2) passed simultaneously. To compare the performance of craniocerebral injury patients with continuous craniocerebral CT (PHI). (3) after 6 months of treatment, the follow-up was divided into GOS4 ~ 5 (good prognosis good prognosis) and 1-3 points (poor prognosis poor prognosis). The difference of coagulation function between each group was compared and the relationship between the changes of coagulation function and prognosis of brain injury was observed. Data collection was used SPS S13.0 carries out statistical processing and analysis.
Results: the levels of APTT, PT and INR were significantly higher in the light, middle and severe craniocerebral injury group than in the control group, while the FG level was significantly lower than that of the control group (P0.05). The more the damage degree was APTT, the higher the level of PT, INR, the lower the FG level (P0.05). The INR content was significantly higher than that of the non progressive intracranial hemorrhage group. There was a significant decrease in progressive intracranial hemorrhage (P0.05). FG, INR and PLT abnormalities in the poor prognosis group were significantly different from those in the good prognosis group (P0.05).
Conclusion: there is abnormal coagulation function after acute craniocerebral injury, which is closely related to the degree of craniocerebral injury. It can be used to judge the prognosis of acute craniocerebral injury. The changes of PT, FG and INR in early plasma can be used as predictors of intracranial hemorrhage in craniocerebral injury.
The second part: risk factors of intracranial progressive hemorrhage after craniocerebral injury.
Objective: To explore the risk factors of intracranial progressive hemorrhage after acute craniocerebral injury.
Methods: the clinical data of 154 cases of closed craniocerebral injury treated in our department of neurosurgery from February 2011 to August 2012 were analyzed. According to the progress of intracranial hemorrhage, they were divided into hemorrhagic group (n=62) and non hemorrhagic group (n=92). The different sex, age, Glasgow coma score (GCS) and the time of the first CT examination were compared. HCT1), the type and location of injury, the effect of the first CT hematoma on the occurrence of progressive hemorrhage (PHI), and the risk factors of the occurrence of the disease. The risk factors of intracranial progressive hemorrhage were analyzed by Logistic regression.
Results: 62 cases (40.2%) had progressive bleeding in this study. Among the 154 patients of this study, 44 had progressive hemorrhage in 105 men, 18 of the 49 women had progressive bleeding, and there was no significant difference between the two groups; the minimum age was 18, the largest was 72 years old, and the average age of the progressive bleeding group was higher than the non progressive hemorrhage group (P0.05). 123 patients were hospitalized with CT scan within 2 hours after injury, and the incidence of PHI was higher in patients with shorter hospitalization time (P0.05); the patients with lower GCS scores were higher than those in the GCS group with a higher score (P0.05). The first CT in the subdural hematoma and intracerebral hematoma after the injury increased the incidence of PHI (P0.05). P0.05). The use of multiple factor Logistic regression analysis showed that the progressive bleeding group and the non progressive hemorrhage group were in the post injury, the age, the injury to the first CT scan, and the early CT manifestations of the brain contusion, the skull fracture, the subarachnoid hemorrhage, and the epidural hematoma were all the risk factors (P0.01).
Conclusion: many factors can participate in intracranial progressive hemorrhage injury after craniocerebral injury. Patients of large age, the time of injury to the first CT examination is short, early CT shows skull fracture, cerebral contusion, subarachnoid hemorrhage, epidural hematoma, should check the brain CT in time, understand the change of the patient's condition, make the patient get the timely treatment And treatment to improve the success rate of TBI patients.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R651.15

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