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目的研究急性颅脑损伤后早期凝血-纤溶功能的变化与进展性颅内出血(PIH)的关系。方法对498例急性颅脑损伤患者进行前瞻性研究,检测伤后早期血浆凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、凝血酶时间(TT)、D-二聚体(D-D)及血小板(PLT)的含量改变。同时,通过比较颅脑损伤患者连续头颅CT的表现,确定是否发生PIH。分析凝血-纤溶指标异常者PIH的发生率及PIH与非PIH患者凝血-纤溶指标含量的差异。结果在纳入研究的498例患者中,139人(27.91%)发生PIH。PT、Fg、TT、PLT、D-D异常者PIH的发生率均明显高于其正常者PIH的发生率(P<0.05)。其中PIH患者在伤后早期血浆PT、D-D含量比非PIH患者明显升高,而血浆Fg含量显著下降(P<0.05)。结论急性颅脑损伤早期血浆PT、D-D、Fg含量的变化,可作为PIH发生的预测因素,对凝血-纤溶功能异常者,应早期连续复查头颅CT,以使PIH患者能及时得到诊治。
Objective To study the relationship between the changes of coagulation and fibrinolysis and the progress of intracranial hemorrhage (PIH) after acute craniocerebral injury. Methods 498 patients with acute craniocerebral injury were prospectively studied. The levels of prothrombin time (PT), partial thromboplastin time (APTT), fibrinogen (Fg), thrombin time (TT) D-dimer (DD) and platelet (PLT) content changes. At the same time, by comparing the performance of CT craniocerebral injury patients to determine whether the occurrence of PIH. The incidence of PIH in patients with abnormal coagulation - fibrinolysis and the difference of coagulation - fibrinolysis between PIH and non - PIH patients were analyzed. Results Of the 498 patients enrolled in the study, 139 (27.91%) developed PIH. The incidences of PIH in PT, Fg, TT, PLT and D-D abnormalities were significantly higher than those in normal controls (P <0.05). PIH patients in the early post-injury plasma PT, D-D levels were significantly higher than non-PIH patients, while plasma Fg levels were significantly decreased (P <0.05). Conclusion The changes of plasma PT, D-D and Fg in early stage of acute craniocerebral injury may be used as predictors of the occurrence of PIH. For patients with abnormal coagulation-fibrinolytic function, skull CT should be continuously reviewed early so that PIH patients can be diagnosed and treated promptly.