河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (3): 286-289，306.doi: 10.3969/j.issn.1007-3205.2022.03.008

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凝血功能指标对严重创伤性脑损伤患者预后的影响

  

  1. 1.华中科技大学同济医学院附属梨园医院手术室，湖北 武汉 430077；2.河北省承德市中心医院神经内科，河北 承德 067000
  • 出版日期:2022-03-25 发布日期:2022-04-14
  • 作者简介:池诚（1983-），女，湖北武汉人，华中科技大学同济医学院附属梨园医院护师，医学学士，从事手术护理研究。
  • 基金资助:

    湖北省自然科学基金资助项目（2017CFB757）

The influence of coagulation function indexes on the prognosis of patients with severe traumatic brain injury

  1. 1.Department of Operating Room, Liyuan Hospital of Tongji Medical College, Huazhong University of

    Science and Technology, Hubei Province, Wuhan 430077，China; 2.Department of Neurology, Chengde Central Hospital, Hebei Province, Chengde 067000， China

  • Online:2022-03-25 Published:2022-04-14

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摘要：

目的 探讨严重创伤性脑损伤(severe traumatic brain injury，sTBI)患者凝血功能变化对其短期预后的预测作用。

方法 回顾性收集并分析sTBI患者329例的临床资料。根据患者出院时预后，分为预后不良组139例和预后良好组190例。收集2组入院时凝血功能指标，采用多因素Logistic分析评估凝血功能指标对患者预后的影响。

结果 预后不良组凝血功能障碍发生率高于预后良好组，维蛋白原（fibrinogen,Fib）低于预后良好组，入院时中线移位＞5 mm、瞳孔对光反应双阴、行急性手术比例高于预后良好组（P＜0.05），活化部分凝血活酶时间（activated partial thromboplastin time，APTT）、凝血酶原时间（prothrombin time，PT）长于预后良好组（P＜0.05）。多因素Logistic回归分析结果显示， PT＞14.6 s(OR=1.66,95%CI:1.23~4.12,P=0.006)、APTT＞39.3 s(OR=1.38, 95%CI:1.15~2.97,P=0.010)是sTBI患者预后的危险因素，Fib＞2.7 g/L(OR=0.79, 95%CI:0.32~0.89,P=0.024)是其保护因素。ROC曲线显示，PT预测sTBI患者预后不良的AUC［0.843(95%CI:0.783~0.902, P＜0.001)］高于Fib［0.735(95%CI:0.658~0.811, P＜0.001)］、APTT［0.762(95%CI:0.691~0.833, P＜0.001)］。

结论 sTBI患者合并凝血功能障碍较常见，PT、APTT延长，Fib降低患者的短期死亡风险增加，且以PT的预测价值最高。

关键词: 颅脑损伤, 凝血功能, 预后

Abstract:

Objective To explore the role of changes in coagulation function in predicting short-term prognosis in patients with severe traumatic brain injury (sTBI).

Methods Clinical data of 329 sTBI patients were retrospectively collected and analyzed. According to the prognosis at discharge, the patients were divided into poor prognosis group(n=139) and good prognosis group(n=190). Coagulation function indexes at admission were collected from the two groups, and the influence of coagulation function indexes on patients′ prognosis was evaluated by multivariate Logistic analysis.

Results  The incidence of coagulation dysfunction in the poor prognosis group was higher than that in the good prognosis group, while the fibrinogen(Fib) was lower than that in the good prognosis group; the proportion of midline shift＞5 mm on admission, double negative pupil response to light, and acute surgery was higher than that in the good prognosis group(P＜0.05). Activated partial thromboplastin time(APTT) and prothrombin time(PT) were longer than those in the good prognosis group(P＜0.05). Multivariate Logistic regression analysis showed that PT＞14.6 s(OR=1.66, 95%CI: 1.23-4.12, P=0.006), and APTT＞39.3 s(OR=1.38, 95%CI: 1.15-2.97, P=0.010) were independent risk factors for poor prognosis in patients with sTBI, and Fib＞2.7 g/L(OR=0.79, 95%CI: 0.32-0.89, P=0.024) was its protective factor. The ROC curve showed that the AUC［0.843(95%CI:0.783-0.902, P＜0.001)］ for PT to predict poor prognosis of sTBI patients was higher than Fib［0.735(95%CI:0.658-0.811, P＜0.001)］ and APTT［ 0.762(95%CI: 0.691-0.833, P＜0.001)］.

Conclusion sTBI patients with coagulation dysfunction are more common. PT and APTT are prolonged, while Fib is reduced. The short-term mortality risk of patients is increased, and PT has the highest predictive value.

Key words: craniocerebral trauma, coagulation function, prognosis

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