戴俊芬　余国峰

[摘要] 目的 探究不同程度颅脑损伤患者凝血功能障碍发生情况及对患者预后的影响。 方法 选取2017年9月至2018年8月我院收治的顱脑损伤患者75例，按照患者颅脑损伤程度分为轻度组、中度组和重度组，每组各25例，所有患者均接受3个月治疗，比较治疗后三组患者凝血功能指标水平及预后情况。 结果 治疗后，重度组PT为（16.24±2.73）s、APTT为（45.67±2.39）s、TT为（16.15±1.22）s，长于中度组[（15.55±2.52）s、（38.55±2.82）s、（15.65±0.82）s]和轻度组[（11.61±2.13）s、（31.12±1.54）s、（15.35±0.58）s]，差异有统计学意义（P<0.05）;治疗后，重度组FIB水平为（1.17±0.33） g/L，低于重度组和轻度组，差异有统计学意义（P<0.05）;治疗后，重度组GCS评分为（10.62±1.72）分，低于轻度组和中度组[（14.21±1.93）分、（12.70±1.63）分]，重度组ADL评分为（65.31±2.83）分，低于轻度组和中度组[（91.25±3.21）分、（82.62±2.54）分]，差异均有统计学意义（P<0.05）;重度组出现继发脑损伤14例，明显高于中度组的9例和轻度组的3例，差异有统计学意义（P<0.05）。 结论 患者颅脑损伤程度可依据PT和APTT水平进行判定，凝血功能异常程度越大患者颅脑损伤的预后能力越差，借助凝血功能障碍来判断患者颅脑损伤程度的方式值得临床推广应用。

[关键词] 不同程度;颅脑损伤;凝血功能;障碍;预后

[中图分类号] R651.1          [文献标识码] B          [文章编号] 1673-9701（2021）06-0068-03

The occurrence of coagulation disorder in patients with variant degrees of craniocerebral injury and its influence on the prognosis of the patients

DAI Junfen   YU Guofeng

Department of Neurosurgery， People′s Hospital of Quzhou in Zhejiang Province， Quzhou   324000， China

[Abstract] Objective To investigate the occurrence of coagulation disorder in patients with variant degrees of craniocerebral injury and its influence on the prognosis of the patients. Methods A total of 75 patients with craniocerebral injury admitted to and treated in our hospital from September 2017 to August 2018 were selected. According to the degree of craniocerebral injury， the patients were divided into mild group， moderate group and severe group， 25 cases in each group. All patients were treated for 3 months. The coagulation function and prognosis of the three groups were compared after treatment. Results After treatment， PT， APTT and TT in severe group were（16.24±2.73） s， （45.67±2.39） s and （16.15±1.22） s， which were longer than those in moderate group（[15.55±2.52] s， [38.55±2.82] s， [15.65±0.82] s） and mild group（[11.61±2.13] s， [31.12±1.54] s， [15.35±0.58] s）， and the difference was statistically significant（P<0.05）. After treatment， the FIB level of severe group was（1.17±0.33） g/L， which was lower than that of severe group and mild group（P<0.05）. After treatment， the GCS score of severe group was（10.62±1.72） points， which was lower than that of mild group and moderate group（[14.21±1.93] points， [12.70±1.63] points）， and the ADL score of severe group was（65.31±2.38） points， which was lower than that of mild group and moderate group（[91.25±3.21] points， [82.62±2.54] points）， and the difference was statistically significant（P<0.05）. There were 14 cases of secondary brain injury in severe group， which were significantly higher than 9 cases in moderate group and 3 cases in mild group（P<0.05）. Conclusion The degree of craniocerebral injury in patients can be determined according to the PT and APTT levels. The greater the degree of coagulation disorder is， the poorer the prognosis ability of the patients with craniocerebral injury is. The method of judging the degree of craniocerebral injury in patients through coagulation disorder is worthy of clinical promotion and application.

[Key words] Variant degrees; Craniocerebral injury; Coagulation function; Disorder; Prognosis

颅脑损伤是比较常见的、属于神经外科的危重型疾病，其有非常高的致死率和致残率，会直接伤害到患者机体，所带来的继发性损伤会影响患者的预后和生存[1]。颅脑损伤极易导致凝血功能障碍，发生概率10%～90%，通常会表现出短暂的高凝状态，之后会表现为消耗性低能状态和纤溶抗凝，增加继发性脑损伤，如迟发性脑出血和脑梗死等[2]。凝血功能障碍也是颅脑损伤中较为常见的并发症之一，有关资料显示，可应用患者凝血功能障碍的具体情况来判断其预后效果和病情状况[3]。本文旨在探究不同程度颅脑损伤患者发生凝血功能障碍的具体情况及对患者预后的影响，现报道如下。

1 资料与方法

1.1 一般资料

选取2017年9月至2018年8月我院收治的颅脑损伤患者75例，按照患者颅脑损伤程度分为轻度组、中度组和重度组，每组各25例。轻度组中男14例，女11例，年龄18～73岁，平均（45.5±1.9）岁;中度组中男16例，女9例，年龄19～76岁，平均（47.5±1.8）岁;重度组中男15例，女10例，年龄17～76岁，平均（46.5±1.7）岁。……