Department of Lab Medicine, Jai Prakash Narayan Apex Trauma Centre, AIIMS, Delhi, India.
Neurol India. 2010 Sep-Oct;58(5):756-7. doi: 10.4103/0028-3886.72175.
Coagulation abnormalities are common in patients with head injuries. However, the effect of brain injury on fibrinogen levels has not been well studied prospectively to assess coagulation abnormalities in patients with moderate and severe head injuries and correlate these abnormalities with the neurologic outcome. Consecutive patients with moderate (Glasgow Comma Scale (GCS),9-12) and severe (GCS≤8) head injuries were the subjects of this pilot study, All patients had coagulation parameters, including plasma fibrinogen levels measured. Clinical and computed tomography (CT) scan findings and immediate clinical outcome were analyzed. Of the 100 patients enrolled, only seven (7%) patients had hypofibrinogenemia (fibrinogen ≤200 mg/dL). The head injury was moderate in two patients and severe in five patients. Fibrinogen levels showed a progressively increasing trend in four patients (three with severe head injuries and one with moderate head injury). CT scan revealed subdural hematoma in five patients; extradural hematoma in one; and subarachnoid hemorrhage in another patient. Of the seven patients, two patients died during hospital. Large-scale prospective studies are needed to assess the fibrinogen level in patients with head injury and its impact on outcome.
颅脑损伤患者常存在凝血异常。然而，前瞻性研究尚未充分研究脑损伤对纤维蛋白原水平的影响，以评估中重度颅脑损伤患者的凝血异常，并将这些异常与神经功能结局相关联。本研究纳入了连续的中重度（格拉斯哥昏迷量表（GCS）评分 9-12 分）颅脑损伤患者，所有患者均检测了凝血参数，包括血浆纤维蛋白原水平。分析了临床和计算机断层扫描（CT）表现及即刻临床结局。在纳入的 100 例患者中，仅有 7 例（7%）患者存在低纤维蛋白原血症（纤维蛋白原≤200mg/dL）。2 例患者为中度颅脑损伤，5 例为重度颅脑损伤。4 例患者的纤维蛋白原水平呈逐渐升高趋势（3 例为重度颅脑损伤，1 例为中度颅脑损伤）。CT 扫描显示 5 例患者存在硬膜下血肿，1 例存在硬膜外血肿，另 1 例存在蛛网膜下腔出血。7 例患者中，2 例患者在住院期间死亡。需要进行大规模前瞻性研究，以评估颅脑损伤患者的纤维蛋白原水平及其对结局的影响。
