摘要
目的探讨失血量和广泛脑组织挫伤与消耗性凝血病的相关性。方法回顾性分析153例重型脑外伤患者凝血功能资料。分别观察失血量≥3000ml与〈3000ml凝血象关系、是否伴有广泛脑组织挫伤的凝血象关系、是否伴有广泛脑组织挫伤的治疗及预后比较、失血量≥3000ml是否伴有广泛脑组织挫伤的治疗预后比较。结果失血量≥3000ml患者与失血量〈3000ml患者比较，活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、凝血酶时间（TT）延长，纤维蛋白原（Fbg）、血小板降低，差异有统计学意义（P〈0．05）。有广泛脑组织挫伤患者与无广泛脑组织挫伤患者比较，APTT、PT、TT延长，Fbg、血小板降低，差异有统计学意义（P〈0．05）。有广泛脑组织挫伤患者输血总量、输新鲜冰冻血浆量均较无广泛脑组织挫伤患者多，前者生存率较后者低[68．29％（28／41）比96．43％（108／112）]，两者比较差异有统计学意义（P〈0．05）。41例广泛脑组织挫伤患者中失血量≥3000ml较〈3000ml输血总量、输冷沉淀量、输血小板量、输新鲜冰冻血浆量增加，预后也更差。结论当创伤后失血量≥3000ml时，患者出现不同程度凝血功能障碍表现，同时伴有创伤后失血量≥3000ml广泛脑组织挫伤时需要进行的凝血干预更多，预后更差。
Objective To study the relevance between blood loss, widespread brain contusion injury and consumptive coagulopathy. Methods One hundred and fifty-three cases with severe brain injury was studied about their eoagnlation data. Analyzed the relationship between blood loss group according to 3000 ml and 〈 3000 mt and coagulation features, the relationship between widespread brain contusion injury and disorder of coagulation;according to whether with brain contusion injury, kinds of bloods transplant and prognosis were assessed;according to whether with widespread brain contusion injury in ≥ 3000 ml blood loss group,kinds of bloods transplant and prognosis were assessed. Results Compared with 〈 3000 ml blood loss patients, ≥ 3000 ml patients＇ blood coagulation changed obviously, with PT prolonging, Fbg and Pit decreasing, the differences were statistically significant （P 〈 0.05 ）. Compared with no extensive brain contusion injury patients, in extensive brain contusion injury patients, APTT, PT, TT prolonged, Fbg and Pit decreased,and the difference was statistically significant （P 〈 0.05）. Extensive brain contusion injury patients with blood loss compared with those without such loss,, needed more blood transfusion volume, larger amount of input of fresh frozen plasma Pit volume, the former survival rate was lower [ 68.29% （28/41） vs. 96.43%（108/112） ], the difference between them was statistically significant （P 〈 0.05 ）. In 41 patients who had brain widespread contusion ,the cases with extensive blood loss （ ≥ 3000 ml） were compared with those 〈 3000 ml, and the differences in blood transfusion treatment, fresh frozen plasma, Pit volume, survival rate were statistically significant （P 〈 0.05 ）. Conclusion When blood loss ≥ 3000 ml after trauma, patients show various degrees of c oagulopathy, and when accompanied with extensive brain tissue injury, coagulation disorders are more obvious, and the prognosis is even worse.
出处
《中国医师进修杂志》
2011年第11期30-32,共3页
Chinese Journal of Postgraduates of Medicine
关键词
脑损伤
血液凝固障碍
失血量
Brain injuries
Blood coagulation disorders
Consumptive coagulopathy
