中重型颅脑损伤后凝血功能变化及DIC评分对预后判断临床研究

发布时间：2018-05-17 07:03

  本文选题：颅脑损伤 + 凝血　； 参考：《山西医科大学》2017年硕士论文

【摘要】：目的:颅脑损伤(traumatic brain injury,TBI)是神经外科、创伤医学常见疾病,无论是发病率、致残率还是死亡率都较高。颅脑损伤后往往伴随着凝血功能的变化,尤其中重型颅脑损伤。近年来颅脑损伤后凝血功能的变化越来越引起创伤医学和神经外科界的关注。本课题通过监测中重型颅脑损伤后凝血指标变化,研究颅脑损伤患者病情是否与凝血指标存在一定的关联性,并探讨凝血指标、DIC评分对预后的判断。方法:收集74例山西医科大学附属山西大医院神经外科2016年1月-2016年6月中重型颅脑创伤(24h内入院,GCS评分小于等于12分)患者的住院病例,根据GCS(Glasgow Coma Score)评分,分为中型颅脑损伤(29例),重型颅脑损伤(45例)。并收集来山西大医院行健康体检的20名社会人员为对照组。颅脑损伤的患者均在受伤后24小时内行凝血指标与血小板计数检验。进入最后统计74例病例均排除了以下情况:颅脑损伤合并重要脏器严重损伤或衰竭者;既往有肝病、糖尿病、血液病等可能影响凝血功能的患者;血标本采集之前,给与输注全血或血制品的患者;血标本采集之前,给予急诊手术者;血标本采集之前,使用影响凝血功能的食物或药物患者。根据凝血指标与血小板计数计算出DIC评分,以了解凝血指标及DIC评分与颅脑损伤轻重的关系。对所有患者在创伤后6个月进行病情随访,并根据随访结果按格拉斯哥预后分级(Glasgowoutcomescale,GOS)分组:分为预后良好组(4-5分),预后不良组(1-3分)。对收集的样本进行统计学分析,应用SPSS17.0统计软件处理数据,全部计量资料用均数±标准差(mean±standard deviation)表示,各组间采用t检验、p0.05为有统计学意义,并行ROC曲线,计算曲线下面积。结果:颅脑损伤后很容易引起凝血功能的变化,本研究中重型颅脑损伤患者中,凝血功能异常总体发生率为86.5%,其中中型、重型颅脑损伤凝血异常发生率分别为79.3%、91.1%。根据GCS评分分组,其中凝血指标PT、TT、Fib、D-二聚体显著变化,并具有统计学意义;而凝血指标APTT、AT-Ⅲ、血小板变化无统计学意义。根据GOS评分分组,其中PT、D-二聚体、DIC评分有显著变化,并具有统计学意义,而TT、APTT、AT-Ⅲ、Fib、血小板变化无统计学意义。根据ROC曲线,计算得出PT、D-二聚体、DIC评分的面积为分别为:0.693、0.646、0.779。结论1.中重型颅脑损伤后,患者广泛存在凝血功能异常。2.中重型颅脑损伤患者中,损伤越重,凝血功能异常发生率越高,凝血指标变化幅度越大。3.PT、D-二聚体、DIC评分能够对预后做出一定的判断;根据ROC曲线,DIC评分较PT、D-二聚体对预后判断更准确、更可靠。
[Abstract]:Objective: traumatic brain injury-tibi (TBI) is a common disease in trauma medicine, which has a high morbidity, disability rate and mortality rate. After craniocerebral injury, coagulation function changes, especially severe craniocerebral injury. In recent years, the changes of coagulation function after craniocerebral injury have attracted more and more attention in trauma medicine and neurosurgery. By monitoring the changes of coagulation indexes after moderate and severe craniocerebral injury, this paper studies whether the condition of patients with craniocerebral injury is related to coagulation indexes, and probes into the prognostic value of coagulation index (DIC). Methods: a total of 74 hospitalized patients with severe craniocerebral trauma (GCS(Glasgow Coma score < 12) in neurosurgery Department of Shanxi Medical University affiliated to Shanxi Medical University from January 2016 to June 2016 were collected. There were 29 cases of moderate craniocerebral injury and 45 cases of severe craniocerebral injury. And collect 20 social personnel that come to Shanxi big hospital to carry out health check-up as control group. Patients with craniocerebral injury were examined for coagulation and platelet count within 24 hours after injury. In the final count of 74 cases, the following conditions were excluded: patients with craniocerebral injury complicated with severe injury or failure of important organs; patients with liver disease, diabetes mellitus, hematologic diseases, etc., who may affect coagulation function; before blood samples were collected, A patient who infuses whole blood or blood products; who is given emergency surgery before the collection of blood samples; and who uses food or drugs that affect the clotting function before the collection of blood samples. DIC score was calculated according to coagulation index and platelet count in order to understand the relationship between coagulation index and DIC score and the severity of craniocerebral injury. All patients were followed up 6 months after trauma. According to the results of follow-up, Glasgow outcomer scale GOS was divided into four groups: good prognosis group (4-5 points) and poor prognosis group (1-3 points). The collected samples were analyzed statistically, and the data were processed by SPSS17.0 statistical software. All the measurement data were expressed as mean 卤standard deviation (mean 卤standard deviation). The t test was used to calculate the area under the curve. Results: it was easy to change the coagulation function after craniocerebral injury. The total incidence of abnormal coagulation function was 86.5 in the patients with moderate and severe craniocerebral injury. The abnormal rate of coagulation in type and severe craniocerebral injury was 79.3% and 91.1%, respectively. According to the GCS score group, the coagulation index PTT TTB D dimer was significantly changed with statistical significance, but the coagulation index APTTT AT- 鈪，

本文编号：1900408