Department of Neurosurgery, S.M.S. Medical College, Jaipur, India.
J Neurotrauma. 2009 Oct;26(10):1665-8. doi: 10.1089/neu.2008.0799.
Abnormalities of blood coagulation are frequently found in patients following traumatic brain injury. Exposure to thromboplastin, which is abundant in brain, plays an important role in initiating coagulopathy. Eighty patients of moderate-to-severe head injury were screened for platelet count, prothombin time (PT), activated partial thromboplastin time (a-PPTK), fibrinogen degradation product levels (FDP), D-dimer levels, and disseminated intravascular coagulation scores (DIC), calculated within the first 24 hours of injury. Increased consumptive coagulopathy at admission, as reflected by high DIC scores, predicted mortality in both moderate and severe head injury patients with a high degree of accuracy (p < 0.001). Similarly, increased PT, FDP, and D-dimer values correlated with higher mortality in both groups, but platelet counts and a-PPTK values correlated with mortality only in the severe head injury group. From this study we conclude that hemostatic abnormalities are independent predictors of early mortality in moderate-to-severe head injury patients.
颅脑损伤患者常伴有凝血功能异常。大量存在于脑组织中的促凝血酶原物质在引发凝血功能障碍中发挥重要作用。本研究对 80 例中重度颅脑损伤患者于伤后 24 小时内进行血小板计数、凝血酶原时间（PT）、活化部分凝血活酶时间（a-PTT）、纤维蛋白原降解产物（FDP）、D-二聚体水平及弥散性血管内凝血评分（DIC）检测。入院时高 DIC 评分提示消耗性凝血病，可准确预测中重度颅脑损伤患者的死亡率（p < 0.001）。PT、FDP、D-二聚体水平升高与两组患者死亡率均相关，但血小板计数及 a-PTT 仅与重度颅脑损伤患者死亡率相关。本研究表明，凝血异常是中重度颅脑损伤患者早期死亡的独立预测因素。
