中国医科大学学报

中国医科大学学报

中国医科大学学报 ›› 2016, Vol. 45 ›› Issue (3): 209–213.doi: 10.12007/j.issn.0258-4646.2016.03.005

• 论著 • 上一篇    下一篇

急性单发性创伤性颅脑损伤术后凝血功能障碍与肝功能异常的相关性

包义君1,王鹏飞2,陶山伟1,李力卓3,4,张德威1,黄小龙1,张文泰1,赵丹1,王运杰1   

  1. 1中国医科大学附属第一医院神经外科,沈阳110001;2河北北方学院第一附属医院神经外科,河北张家口075000;3中国医科大学附属盛京医院急诊科,沈阳110004;4海南医学院附属医院急危重症医学部,海口570102
  • 收稿日期:2015-12-03 出版日期:2016-02-29 发布日期:2016-02-24
  • 作者简介:包义君(1975 -),男,副教授,博士.
  • 基金资助:
    教育部留学回国人员科研启动基金(教外司留[2013]1792号);辽宁省自然科学基金(2015020460,2013021083);沈阳市科技创新专项基金人口与健康科技攻关专项(F13?220?9?53)

Correlation of Post-operative Coagulopathy with Liver Function in Patients with Acute Isolated Traumatic Brain Injury

BAO Yi-jun1,WANG Peng-fei2,TAO Shan-wei1,LI Li-zhuo3,4,ZHANG De-wei1,HUANG Xiao-long1,ZHANG Wen-tai1,ZHAO Dan1,WANG Yun-jie1   

  1. 1Department of Neurosurgery,The First Hospital,China Medical University,Shenyang 110001,China;2Department of Neurosurgery,The First Hospital of Hebei North University,Zhangjiakou 075000,China;3Emergency Department,Shengjing Hospital,China Medical University,Shenyang 110004,China;4Department of CriticalCareandEmergencyMedicine,TheAffiliatedHospitalofHainanMedicalUniversity,Haikou570102,China
  • Received:2015-12-03 Online:2016-02-29 Published:2016-02-24

摘要: 目的 分析急性单发性创伤性颅脑损伤术后凝血功能障碍与肝功能异常的关系。方法 顾性分析我科2012年1月至2014年12月收治的满足入组条件的凝血功能障碍患者51例,按照1∶3配比进行病例对照研究,分析术后凝血功能障碍的发生与肝功能的相关性。结果将配比的凝血功能障碍组和对照组患者按照格拉斯哥昏迷评分(GCS)分为重型颅脑损伤(GCS 3~8分)和轻中型颅脑损伤(GCS 9~15分),结果 明术后凝血功能障碍的发生与创伤性颅脑损伤的严重程度相关(P <0.001)。在重型颅脑损伤中,肝功能指标丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)与术后凝血功能障碍呈正相关(P = 0.008,OR =4.318,95% CI 1.429~13.053和P = 0.036,OR =3.109,95% CI 1.064~9.081),而在轻中型颅脑损伤中ALT和AST与术后凝血功能障碍无明显相关性(P > 0.05)。其他指标碱性磷酸酶、γ-谷氨酰基转移酶和总胆红素无论在重型还是轻中型颅脑损伤中,均与术后凝血功能障碍无统计学相关性(P > 0.05)。结论 性单发性创伤性重型颅脑损伤术后凝血功能障碍与肝功能异常密切相关,临床医生不应忽视手术后凝血功能障碍的发生,应在围手术期严密监测肝功能并纠正肝功能异常,防止术后凝血功能障碍的出现,改善患者预后。

关键词: 急性单发性创伤性颅脑损伤, 凝血功能障碍, 肝功能

Abstract: Objective To evaluate the correlation between liver function and post-operative traumatic coagulopathy in patients with acute isolated raumatic brain injury. Methods A retrospective analysis was carried out including 51 post-operative coagulopathy cases and 153 matched control cases of acute isolated traumatic brain injury according to the inclusion and exclusion criteria from January 2012 to December 2014. The correlation between liver function and post-operative coagulopathy was assessed. Results According to Glasgow coma scale(GCS),the included cases were classified as the severe group(GCS 3-8)and mild-moderate group(GCS 9-15). The positive correlation was shown between post-operative coagulopathy and liver dysfunction(P < 0.001). In the cases of severe traumatic brain injury,alanine aminotransferase and aspartate transaminase were positively correlated with post-operative coagulopathy(P = 0.008,OR =4.318,95% CI 1.429-13.053 and P = 0.036,OR =3.109,95% CI 1.064-9.081),but not correlated in mild-moderate brain injury(P > 0.05). In contrast,there were no significant differences for alkaline phosphatase,γ-glutamyl transpeptidase and total bilirubin in both sever group and mild-moderate group(P > 0.05). Conclusion There is a close relationship between liver dysfunction and post-operative coagulopathy in patients with acute isolated severe traumatic braininjury,which indicates that the monitoring and correction of liver dysfunction are vital for the prediction of post-operative coagulopathy and the recovery of the patients.

Key words: acute isolated traumatic brain injury, coagulopathy, liver function

中图分类号: 

  • R651.1
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