中国医科大学学报

中国医科大学学报
  • 中文核心期刊
  • 中国科技核心期刊
  • 中国高校百佳科技期刊
  • BA、CA收录

中国医科大学学报 ›› 2019, Vol. 48 ›› Issue (5): 425-429.doi: 10.12007/j.issn.0258-4646.2019.05.011

• 论著 • 上一篇    下一篇

严重创伤性脑损伤后凝血功能障碍与预后的关系

常盼盼1, 刘畅2, 崇巍2   

  1. 1. 中国医科大学附属第一医院 神经外科, 沈阳 110001;
    2. 中国医科大学附属第一医院 急诊科, 沈阳 110001
  • 收稿日期:2018-02-02 出版日期:2019-05-30 发布日期:2019-05-15
  • 通讯作者: 崇巍 E-mail:wchong@cmu.edu.cn
  • 作者简介:常盼盼(1990-),男,博士研究生.

Relationship between Outcomes of Severe Traumatic Brain Injury and Coagulopathy

CHANG Panpan1, LIU Chang2, CHONG Wei2   

  1. 1. Department of Neurosurgery, The First Hospital, China Medical University, Shenyang 110001, China;
    2. Department of Emergency Medicine, The First Hospital, China Medical University, Shenyang 110001, China
  • Received:2018-02-02 Online:2019-05-30 Published:2019-05-15

摘要: 目的探讨严重创伤性脑损伤(sTBI)后凝血功能障碍与预后的关系。方法选取2013年11月至2014年11月我院急诊神经外科收治的58例sTBI患者。对患者sTBI后凝血功能障碍与预后的关系进行单因素分析(以P<0.15为有统计学意义),并对有显著性差异的因素进行多因素logistic回归分析(以P<0.10为有统计学意义),最后将多因素分析得出的独立危险因素绘制成受试者工作特征(ROC)曲线。结果患者凝血功能障碍发生率31.03%,死亡率24.14%。凝血酶原时间(PT,β=-1.200,OR=0.031,P=0.082)、活化部分凝血活酶时间(APTT,β=0.293,OR=1.340,P=0.073)为预后不良的独立危险因素; ROC曲线下面积分别为0.717、0.558。结论 PT、APTT是sTBI患者预后不良的独立危险因素,sTBI后凝血功能障碍与预后不良有一定相关性。

关键词: 严重创伤性脑损伤, 凝血功能障碍, 凝血酶原时间, 活化部分凝血活酶时间, 预后, 相关分析

Abstract: Objective To assess the relationship between coagulation disorders and outcomes of severe traumatic brain injury(sTBI). Methods A retrospective study was conducted,including 58 patients with sTBI in our emergency department from November 2013 to November 2014. Significance was determined by a single-factor analysis followed by nonconditional multivariate logistic regression analysis. Subsequently,receiver operating characteristic curves(ROC curves)were drawn,based on the analysis. Results The study included 41 males and 17 females from the ages of 12 to 88 years. The occurrence of TBI-related coagulopathy was found to be 31.03%,while mortality in the patients was 24.14%. Additionally,prothrombin time(PT,β=-1.200,OR=0.031,P=0.082)and activated partial thromboplastin time(APTT,β=0.293,OR=1.340,P=0.073)were determined to be independent risk factors for unfavorable prognosis in patients with sTBI. The area under the curve(AUC)of PT and APTT were 0.717 and 0.558,respectively. Conclusion Both PT and APTT are determined to be independent risk factors for unfavorable prognosis in patients with sTBI.

Key words: severe traumatic brain injury, coagulation disorders, prothrombin time, activated partial thromboplastin time, outcome, relationship

中图分类号: 

  • R641
[1] EPSTEIN DS,MITRA B,O'REILLY G,et al. Acute traumatic coagulopathy in the setting of isolated traumatic brain injury:a systematic review and meta-analysis[J]. Injury,2014,45(5):819-824. DOI:10.1016/j.injury.2014.01.011.
[2] HARHANGI BS,KOMPANJE EJ,LEEBEEK FW,et al. Coagulation disorders after traumatic brain injury[J]. Acta Neurochir(Wien), 2008,150(2):165-175. DOI:10.1007/s00701-007-1475-8.
[3] HESS JR,BROHI K,DUTTON RP,et al. The coagulopathy of trauma:a review of mechanisms[J]. J Trauma,2008,65(4):748-754. DOI:10.1097/TA.0b013e3181877a9c.
[4] BROHI K,COHEN MJ,GANTER MT,et al. Acute coagulopathy of trauma:hypoperfusion induces systemic anticoagulation and hyperfibrinolysis[J]. J Trauma,2008,64(5):1211-1217. DOI:10.1097/TA.0b013e318169cd3c.
[5] MITRA B,CAMERON PA,MORI A,et al. Early prediction of acute traumatic coagulopathy[J]. Resuscitation,2011,82(9):1208-1213. DOI:10.1016/j.resuscitation.2011.04.007.
[6] DE OLIVEIRA MANOEL AL,NETO AC,VEIGAS PV,et al. Traumatic brain injury associated coagulopathy[J]. Neurocrit Care,2015, 22(1):34-44. DOI:10.1007/s12028-014-0026-4.
[7] ZHANG J,JIANG R,LIU L,et al. Traumatic brain injury-associated coagulopathy[J]. J Neurotrauma,2012,29(17):2597-2605. DOI:10.1089/neu.2012.2348.
[8] WINTER JP,PLUMMER D,BOTTINI A,et al. Early fresh frozen plasma prophylaxis of abnormal coagulation parameters in the severely head-injured patient is not effective[J]. Ann Emerg Med,1989,18(5):553-555.
[9] SEN O,SONMEZ E,CEKINMEZ M,et al. Antithrombin Ⅲ and enoxaparin treatment inhibit contusion-triggered cell death,inflammation,hemorrhage and apoptosis after severe traumatic brain injury in rats[J].Turk Neurosurg,2011,21(2):203-209. DOI:10.5137/1019-5149.JTN.3646-10.1.
[10] DUDLEY RR,AZIZ I,BONNICI A,et al. Early venous thromboembolic event prophylaxis in traumatic brain injury with low-molecular-weight heparin:risks and benefits[J]. J Neurotrauma,2010,27(12):2165-2172. DOI:10.1089/neu.2010.1366.
[11] BROWN CV,SOWERY L,CURRY E,et al. Recombinant factor VⅡa to correct coagulopathy in patients with traumatic brain injury presenting to outlying facilities before transfer to the regional trauma center[J]. Am Surg,2012,78(1):57-60.
[12] WAHLSTROM MR,OLIVECRONA M,AHLM C,et al. Effects of prostacyclin on the early inflammatory response in patients with traumatic brain injury-a randomised clinical study[J]. Springerplus, 2014,3:98. DOI:10.1186/2193-1801-3-98.
[13] DAVENPORT R,MANSON J,DE'ATH H,et al. Functional definition and characterization of acute traumatic coagulopathy[J]. Crit Care Med, 2011,39(12):2652-2658. DOI:10.1097/CCM.0b013e3182281af5.
[14] GUILLOTTE AR,HERBERT JP,MADSEN R,et al. Effects of platelet dysfunction and platelet transfusion on outcomes in traumatic brain injury patients[J]. Brain Inj,2018,32(13/14):1849-1857. DOI:10.1080/02699052.2018.1536805.
[15] TALVING P,BENFIELD R,HADJIZACHARIA P,et al. Coagulopathy in severe traumatic brain injury:a prospective study[J]. J Trauma,2009,66(1):55-61. DOI:10.1097/TA.0b013e318190c3c0.
[16] GREUTERS S,VAN DEN BERG A,FRANSCHMAN G,et al. Acute and delayed mild coagulopathy are related to outcome in patients with isolated traumatic brain injury[J]. Crit Care,2011,15(1):R2. DOI:10.1186/cc9399.
[17] KIM YJ. A systematic review of factors contributing to outcomes in patients with traumatic brain injury[J]. J Clin Nurs,2011,20(11/12):1518-1532. DOI:10.1111/j.1365-2702.2010.03618.x.
[18] NAJEM D,RENNIE K,RIBECCO M,et al. Traumatic brain injury:classification,models and markers[J]. Biochem Cell Biol,2018,96(4):391-406. DOI:10.1139/bcb-2016-0160.
[19] HAYAKAWA M,MAEKAWA K,KUSHIMOTO S,et al. Hyperfibrinolysis in severe isolated traumatic brain injury may occur without tissue hypoperfusion:a retrospective observational multicentre study[J]. Crit Care,2017,21(1):222. DOI:10.1186/s13054-017-1811-1.
[20] MARTIN GE,XIA B,KIM Y,et al. Platelet function changes in a time-dependent manner following traumatic brain injury in a murine model[J]. Shock,2017,50(5):551-556. DOI:10.1097/SHK.0000000000001056.
[21] PAHATOURIDIS D,ALEXIOU GA,ZIGOURIS A,et al. Coagulopathy in moderate head injury. The role of early administration of low molecular weight heparin[J]. Brain Inj,2010,24(10):1189-1192. DOI:10.3109/02699052.2010.490510.
[22] MURSHID WR,GADER AG. The coagulopathy in acute head injury:comparison of cerebral versus peripheral measurements of haemostatic activation markers[J]. Br J Neurosurg,2002,16(4):362-369.
[23] ALBERT V,SUBRAMANIAN A,AGRAWAL D,et al. Acute traumatic endotheliopathy in isolated severe brain injury and its impact on clinical outcome[J]. Med Sci(Basel),2018,6(1):E5. DOI:10.3390/medsci6010005.
[24] ZHANG D,GONG S,JIN H,et al. Coagulation parameters and risk of progressive hemorrhagic injury after traumatic brain injury:a systematic review and meta-analysis[J]. Biomed Res Int,2015,2015:261825. DOI:10.1155/2015/261825.
[25] LEE JC,RITTENHOUSE K,BUPP K,et al. An analysis of Brain Trauma Foundation traumatic brain injury guideline compliance and patient outcome[J]. Injury,2015,46(5):854-858. DOI:10.1016/j.injury.2014.12.023.
[26] YOUNG AMH,ADAMS H,DONNELLY J,et al. Glycemia is related to impaired cerebrovascular autoregulation after severe pediatric traumatic brain injury:a retrospective observational study[J]. Front Pediatr,2017,5:205. DOI:10.3389/fped.2017.00205.
[27] REHEMAN A,YANG H,ZHU G,et al. Plasma fibronectin depletion enhances platelet aggregation and thrombus formation in mice lacking fibrinogen and von Willebrand factor[J]. Blood,2009,113(8):1809-1817. DOI:10.1182/blood-2008-04-148361.
[28] MURRAY GD,BUTCHER I,MCHUGH GS,et al. Multivariable prognostic analysis in traumatic brain injury:results from the IMPACT study[J]. J Neurotrauma,2007,24(2):329-337. DOI:10.1089/neu.2006.0035.
[29] WU X,DU Z,YU J,et al. Activity of factor Ⅶ in patients with isolated blunt traumatic brain injury:association with coagulopathy and progressive hemorrhagic injury[J]. J Trauma Acute Care Surg, 2014,76(1):114-120. DOI:10.1097/TA.0b013e3182a8fe48.
[30] IVES C,INABA K,BRANCO BC,et al. Hyperfibrinolysis elicited via thromboelastography predicts mortality in trauma[J]. J Am Coll Surg, 2012,215(4):496-502. DOI:10.1016/j.jamcollsurg.2012.06.005.
[1] 隋国媛, 贾连群. 冠状动脉粥样硬化性心脏病患者积极心理资源与焦虑的相关分析[J]. 中国医科大学学报, 2019, 48(9): 801-806.
[2] 李玉泽, 刘娜, 佟晶, 金蓉, 陈梅, 卑贵光. 动脉自旋标记灌注对足月缺氧缺血性脑病新生儿预后的预测价值[J]. 中国医科大学学报, 2019, 48(9): 812-816.
[3] 段秋艳, 杜秋红, 宋文玲, 苏嘉利, 徐萍. 血清sTWEAK和MMP-9在急性ST段抬高型心肌梗死患者中的表达及其与预后的关系[J]. 中国医科大学学报, 2019, 48(9): 833-836,851.
[4] 孙翠翠, 张斯萌, 温倜, 曲秀娟, 刘云鹏. 晚期非小细胞肺癌肿瘤生长速率与临床病理特征及预后的相关性[J]. 中国医科大学学报, 2019, 48(8): 673-677.
[5] 韩苏, 王传合, 佟菲, 杨丽娜, 崔文佳, 孙志军. 基于倾向性评分匹配法评估钠离子浓度对心力衰竭患者预后的影响[J]. 中国医科大学学报, 2019, 48(8): 714-718.
[6] 张强, 郑海明, 郑锐. 慢性阻塞性肺疾病急性加重患者体质量指数与病情的相关分析[J]. 中国医科大学学报, 2019, 48(8): 738-742.
[7] 韩苏, 王传合, 佟菲, 杨丽娜, 崔文佳, 孙志军. 性别差异对射血分数中间型心力衰竭患者预后的影响[J]. 中国医科大学学报, 2019, 48(7): 624-628.
[8] 高翔, 刘志宇, 王梁, 戴志红, 汪鑫, 蔡凯. 术前中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值对非肌层浸润性膀胱癌的预后评估价值[J]. 中国医科大学学报, 2019, 48(7): 638-642.
[9] 孙华屹, 张宏, 丛进春. 结肠癌根治术患者临床特征与预后的相关性分析[J]. 中国医科大学学报, 2019, 48(7): 660-662.
[10] 王硕, 郑新宇. 乳腺癌根治术患者化疗相关粒细胞减少与预后的关系[J]. 中国医科大学学报, 2019, 48(6): 542-546.
[11] 董会帅, 范崇渝, 韩云. 肺叶切除与肺段切除治疗肺部磨玻璃结节效果的比较[J]. 中国医科大学学报, 2019, 48(6): 547-550.
[12] 蔡恒, 刘文静, 冯天达, 刘云会. 垂体转移瘤的临床特点及治疗分析:2例病例报道及文献回顾[J]. 中国医科大学学报, 2019, 48(6): 564-567.
[13] 庄莹, 张淑红, 樊伟平, 赵小芳, 孙海燕, 刘爽, 张虎. 乳腺癌中DEAH盒解旋酶16的表达及临床意义[J]. 中国医科大学学报, 2019, 48(4): 305-308.
[14] 胡明, 张淑红, 陈跟林, 凌存宝, 樊伟平, 孙海燕, 刘爽, 张虎. 泛癌症分析DEAH盒解旋酶16的表达及其预后意义[J]. 中国医科大学学报, 2019, 48(3): 201-204.
[15] 郅重阳, 彭良群, 张占东, 李宁, 刘洪兴, 花亚伟. 倾向评分匹配法探讨预后营养指数与胃癌新辅助化疗后病理完全缓解的相关性[J]. 中国医科大学学报, 2019, 48(3): 245-249,254.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 贺雪梅, 熊欣, 邹建中, 李发琪, 龚晓波. 超声消融剂量与生物学焦域特征[J]. 中国医科大学学报, 2009, 38(9): 654 .
[2] 谭明旗, 边明艳. HA14-1诱导小鼠Lewis肺癌细胞凋亡的实验研究[J]. 中国医科大学学报, 2009, 38(9): 668 .
[3] 尹玉, 赵卫华, 胡健. 替米沙坦与非诺贝特对高脂饮食大鼠血清脂联素水平的影响[J]. 中国医科大学学报, 2009, 38(9): 674 .
[4] 孔静, 吴硕东, 范莹, 金俊哲, 石刚. 腹腔镜胰体尾切除及胰腺假性囊肿内引流手术体会[J]. 中国医科大学学报, 2009, 38(9): 690 .
[5] 宋辉. 缺氧诱导因子-1α在喉鳞状细胞癌中的表达及与微血管密度的关系[J]. 中国医科大学学报, 2009, 38(9): 700 .
[6] 郭哲, 徐冰, 卢利. 下颌骨髁突骨折治疗的Meta分析[J]. 中国医科大学学报, 2009, 38(9): 709 .
[7] 夏永辉, 徐克. 对吻式支架置入术治疗Leriche综合征15例体会[J]. 中国医科大学学报, 2009, 38(9): 714 .
[8] 林书坡, 林杰, 史今. 替米沙坦对胰岛素抵抗大鼠肾脏脂联素表达的影响[J]. 中国医科大学学报, 2009, 38(10): 741 .
[9] 刘小霄, 宋薇薇. 印记基因H19和IGF-ⅡmRNA在新生儿胎盘中的表达与出生体质量的关系[J]. 中国医科大学学报, 2009, 38(10): 758 .
[10] 高红, 吕良英, 白伟良, 王大佳, 黄英, 张志波, 王维林. 先天性巨结肠组织蛋白质组成分的双向凝胶电泳分析[J]. 中国医科大学学报, 2009, 38(10): 761 .

中国医科大学学报版权所有©2018

未经允许,严禁擅自转载本站图文资料

地址:中国 沈阳市沈北新区蒲河路77号 110122

辽ICP备05014850

JOURNAL OF CHINA MEDICAL UNIVERSITY

ADDRESS: NO.77 PUHE ROAD

SHENYANG NORTH NEW AREA, SHENYANG

LIAONING PROVINCE, P.R. CHINA