Influence of coagulation function change on the progress and prognosis of acute brain injury

doi:10.3877/cma.j.issn.2095-9141.2020.06.007

Abstract

Abstract:

Objective

To explore the influence of coagulation function on the progress and prognosis of acute brain injury.

Methods

Seventy-one cases of acute brain injury in Guangzhou Brain Hospital and Navy Qingdao Special Service Recuperation Center from January 2017 to December 2018 were analyzed retrospectively. According to GCS score, brain injury was divided into mild, moderate, severe and especially severe, to analyze the relationship between the change of coagulation function before and after operation and the severity of craniocerebral injury, treatment and GOS score.

Results

There were significant differences in international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (D-d) and platlet (PLT) among 4 groups (P<0.05). During the follow-up period from 2 d to 24 months, the good recovery rates of type 4 craniocerebral injury were 93.75%, 80%, 55.55% and 0%, respectively, and the difference was statistically significant (P<0.05). There was a significant positive correlation between the prognosis of acute brain injury and the severity of brain injury (r=0.666, P<0.05). There were significant differences in INR, PT, APTT, FIB and D-d in different brain injury patients with different prognosis (P<0.05), but PLT decreased, the difference was not statistically significant (P>0.05).

Conclusion

Coagulation dysfunction after acute craniocerebral injury has important value for the severity and prognosis of patients, which can provide the basis for the prognosis of acute brain injury.

Key words: Acute brain injury, Coagulation, Prognosis

Xudong Guo, Jiangjie Shen. Influence of coagulation function change on the progress and prognosis of acute brain injury[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2020, 06(06): 356-359.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsjcswkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9141.2020.06.007

https://zhsjcswkdzzz.cma-cmc.com.cn/EN/Y2020/V06/I06/356

Figures/Tables 4

References 15

[1]	Udekwu P, Kromhout-Schiro S, Vaslef S, et al. Glasgow coma scale score, mortality, and functional outcome in head-injured patients[J]. J Trauma, 2004, 56(5): 1084-1089.
[2]	Suresh V, Yaddanapudi LN, Podder S. Full outline of unresponsiveness score versus glasgow coma scale in critically ill patients with altered sensorium: a comparison of inter-observer variability and outcomes[J]. Indian J Anaesth, 2019, 63(8): 640-647.
[3]	Zafonte RD, Hammond FM, Mann NR, et al. Relationship between glasgow coma scale and functional outcome[J]. Am J Phys Med Rehabil, 1996, 75(5): 364-369.
[4]	周立田，杨平来，丁俊宏,等.早期应用重组活化凝血因子Ⅶ对重型颅脑外伤的临床疗效[J].临床神经外科杂志, 2017, 14(5): 374-377.
[5]	唐永峰.冷沉淀治疗脑外伤后凝血功能障碍患者15例临床研究[J].医学信息, 2015, 28(39): 366-367.
[6]	吴文友.血浆辅助治疗颅脑外伤术后凝血功能障碍疗效及其对预后的影响[J].实用临床医药杂志, 2013, 17(24): 51-53.
[7]	王浩，曹烨琳，温良,等.颅脑创伤急诊开颅术前凝血功能障碍与损伤严重程度及预后的相关性研究[J].浙江创伤外科, 2015, 20(4): 685-687.
[8]	叶永造，王占样.颅脑损伤后凝血障碍研究进展[J].中华神经外科疾病研究杂志, 2012, 11(1): 85-87.
[9]	彭涛，陈东亮，张济源,等.重型颅脑外伤并发凝血功能障碍28例诊治分析[C].//全国神经外科高峰论坛暨广西医学会神经外科分会2014年学术年会论文集.南宁:广西医学会, 2014: 138-140.
[10]	MacLeod JB, Lynn M, McKenney MG, et al. Early coagulopathy predicts mortality in trauma[J]. J Trauma, 2003, 55(1): 39-44.
[11]	Hess JR, Lawson JH. The coagulopathy of trauma versus disseminated intravascular coagulation[J]. J Trauma, 2016, 60(6 Suppl), S12-S19.
[12]	Stein SC, Spettell C, Young G, et al. Delayed and progressive brain injury in closed-head trauma: radiological demonstration[J]. Neurosurgery, 1993, 32(1): 25-31.
[13]	蔡侃芝，郝香玲，袁宝华,等.脑外伤围术期凝血功能评估病情及预后的临床意义[J].临床医学, 2017, 37(12): 78-80.
[14]	Gando S, Nanzaki S, Kemmotsu O. Disseminated intravascular coagulation and sustained systemic inflammatory response syndrome predict organ dysfunctions after trauma: application of clinical decision analysis[J]. Ann Surg, 1999, 229(1): 121-127.
[15]	Keel M, Trentz O. Pathophysiology of polytrauma[J]. Injury, 2005, 36(6): 691-709.

颅脑损伤	例数	性别[例(%)]		年龄（岁，±s）	有无系统疾病[例(%)]		受伤时间（h，±s）	治疗方式[例(%)]
颅脑损伤	例数	男	女	年龄（岁，±s）	是	否	受伤时间（h，±s）	开颅手术	保守治疗
轻型	16	13(18.3)	3(4.2)	31.0±5.7	4(5.6)	9(12.7)	6.1±1.0	0(0)	16(22.5)
中型	20	18(25.3)	2(2.8)	53.3±9.1	4(5.6)	14(19.7)	5.3±0.5	7(9.9)	13(18.3)
重型	18	18(25.3)	0(0)	48.1±7.3	3(4.2)	15(21.1)	6.0±0.3	18(25.3)	0(0)
特重型	17	12(16.9)	1(1.4)	36.8±6.2	1(1.4)	11(15.5)	4.0±0.2	11(15.5)	6(8.5)
F/χ²值		4.161		1.021	2.022		0.981	19.010
P值		0.214		0.537	0.547		0.378	0.786

颅脑损伤	例数	性别[例(%)]		年龄（岁，±s）	有无系统疾病[例(%)]		受伤时间（h，±s）	治疗方式[例(%)]
颅脑损伤	例数	男	女	年龄（岁，±s）	是	否	受伤时间（h，±s）	开颅手术	保守治疗
轻型	16	13(18.3)	3(4.2)	31.0±5.7	4(5.6)	9(12.7)	6.1±1.0	0(0)	16(22.5)
中型	20	18(25.3)	2(2.8)	53.3±9.1	4(5.6)	14(19.7)	5.3±0.5	7(9.9)	13(18.3)
重型	18	18(25.3)	0(0)	48.1±7.3	3(4.2)	15(21.1)	6.0±0.3	18(25.3)	0(0)
特重型	17	12(16.9)	1(1.4)	36.8±6.2	1(1.4)	11(15.5)	4.0±0.2	11(15.5)	6(8.5)
F/χ²值		4.161		1.021	2.022		0.981	19.010
P值		0.214		0.537	0.547		0.378	0.786

颅脑损伤	例数	INR	PLT(×10⁹/L)	PT(s)	APTT(s)	FIB(g/L)	D-d(mg/L)
轻型	16	1.78±0.23	112±12.46	14.79±1.35	41.24±2.94	1.46±0.67	1.23±0.78
中型	20	2.13±0.11	106±10.31^a	15.32±2.13^a	42.35±1.08	1.21±0.38^a	1.57±0.21^a
重型	18	2.34±0.13^a	89±6.14^a	16.11±1.74^ab	44.61±2.08^a	1.09±0.34^ab	2.13±0.24^a
特重型	17	2.86±0.09^ab	86±7.32^abc	17.23±1.98^ab	45.98±1.36^abc	0.97±0.48^ab	2.56±0.13^ab
F值		5.401	6.152	4.981	6.980	5.181	6.764
P值		0.002	0.001	0.009	<0.001	0.019	0.001

颅脑损伤	例数	INR	PLT(×10⁹/L)	PT(s)	APTT(s)	FIB(g/L)	D-d(mg/L)
轻型	16	1.78±0.23	112±12.46	14.79±1.35	41.24±2.94	1.46±0.67	1.23±0.78
中型	20	2.13±0.11	106±10.31^a	15.32±2.13^a	42.35±1.08	1.21±0.38^a	1.57±0.21^a
重型	18	2.34±0.13^a	89±6.14^a	16.11±1.74^ab	44.61±2.08^a	1.09±0.34^ab	2.13±0.24^a
特重型	17	2.86±0.09^ab	86±7.32^abc	17.23±1.98^ab	45.98±1.36^abc	0.97±0.48^ab	2.56±0.13^ab
F值		5.401	6.152	4.981	6.980	5.181	6.764
P值		0.002	0.001	0.009	<0.001	0.019	0.001

颅脑损伤	例数	恢复良好	轻度残疾	重度残疾	植物生存	死亡	恢复良好率(%)
轻型	16	15	1	0	0	0	93.75
中型	20	16	2	1	1	0	80.00
重型	18	10	3	3	1	1	55.55
特重型	17	0	1	8	5	3	0
χ²值							34.633
P值							<0.001

Please choose a citation manager

Content to export