Etemadrezaie Hamid, Baharvahdat Humain, Shariati Zhaleh, Lari Shahrzad M, Shakeri Mohammad T, Ganjeifar Babak
Neurosurgical Department, Shahid Kamyab (Emdadi) Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran.
Clin Neurol Neurosurg. 2007 Feb;109(2):166-71. doi: 10.1016/j.clineuro.2006.09.001. Epub 2006 Oct 9.
Traumatic brain injury (TBI) is one of the most common causes of morbidity and mortality. Coagulopathy, commonly occurring after severe TBI, is associated with poor outcome and secondary complications, especially delayed traumatic intracerebral hematoma (DTICH). In this study we evaluated the effect of fresh frozen plasma (FFP) on the reduction in the incidence of DTICH in severe closed head injury victims.
This study was carried out as a double-blind randomized clinical trial. Ninety patients were entered in two parallel groups taking either FFP or normal saline (N/S). Patients' selection criteria for both groups were: severe closed head injury (Glasgow coma scale < or =8), no mass lesion required evacuation and no history of coagulopathy. The clinical findings, laboratory data, computed tomography (CT) scans and Glasgow outcome scale after 1 month were assessed and compared in two groups.
Out of 90 patients, 44 received FFP and 46 received N/S. The development of new intracerebral hematoma in follow-up CT scans were more common in the FFP group than the N/S group (p=0.012). Both groups showed similar frequency of poor outcome (p=0.343). The mortality was significantly more common in the FFP group than in the N/S group (63% versus 35%, p=0.006).
The result of this study revealed that early empirical infusion of FFP in patients with severe head injury may lead to adverse effects, such as an increase in the frequency of DTICH and an increase in the mortality.
创伤性脑损伤（TBI）是发病和死亡的最常见原因之一。凝血功能障碍常见于重度TBI后，与不良预后及继发性并发症相关，尤其是迟发性创伤性脑内血肿（DTICH）。在本研究中，我们评估了新鲜冰冻血浆（FFP）对降低重度闭合性颅脑损伤患者DTICH发生率的作用。
本研究作为一项双盲随机临床试验开展。90例患者被纳入两个平行组，分别输注FFP或生理盐水（N/S）。两组患者的入选标准为：重度闭合性颅脑损伤（格拉斯哥昏迷量表评分≤8分），无需清除占位性病变，且无凝血功能障碍病史。对两组患者1个月后的临床表现、实验室数据、计算机断层扫描（CT）结果及格拉斯哥预后量表进行评估和比较。
90例患者中，44例接受FFP，46例接受N/S。随访CT扫描显示，FFP组新发脑内血肿的发生率高于N/S组（p = 0.012）。两组不良预后的发生率相似（p = 0.343）。FFP组的死亡率显著高于N/S组（63%对35%，p = 0.006）。
本研究结果显示，对重度颅脑损伤患者早期经验性输注FFP可能会导致不良反应，如DTICH发生率增加及死亡率升高。
