Division of Acute Care Surgery (Trauma, Emergency Surgery, and Surgical Critical Care), Keck School of Medicine, University of Southern California-Los Angeles, Los Angeles, California 90033-4525, USA.
J Neurotrauma. 2011 Sep;28(9):1699-706. doi: 10.1089/neu.2011.1866. Epub 2011 Sep 8.
The aim of this study was to determine the impact of ethanol (ETOH) on the incidence of severe traumatic brain injury (sTBI)-associated coagulopathy and to examine the effect of ETOH on in-hospital outcomes in patients sustaining sTBI. Patients admitted to the surgical intensive care unit from June 2005 through December 2008 following sTBI, defined as a head Abbreviated Injury Scale (AIS) score ≥3, were retrospectively identified. Patients with a chest, abdomen, or extremity AIS score >3 were excluded to minimize the impact of extracranial injuries. Criteria for sTBI-associated coagulopathy included thrombocytopenia and/or elevated International Normalized Ratio (INR) and/or prolonged activated partial thromboplastin time (aPTT). The incidence of admission coagulopathy, in-hospital complications, and mortality were compared between patients who were ETOH positive [ETOH (+)] and ETOH negative [ETOH (-)]. During the study period, there were 439 patients with ETOH levels available for analysis. Overall, 46.5% (n=204) of these patients were ETOH (+), while 53.5% (n=235) were ETOH (-). Coagulopathy was significantly less frequent in the ETOH (+) patients compared to their ETOH (-) counterparts (5.4% versus 15.3%; adjusted p<0.001). In the forward logistic regression analysis, a positive ETOH level proved to be an independent protective factor for admission coagulopathy [OR (95% CI)=0.24 (0.10,0.54; p=0.001]. ETOH (+) patients had a significantly lower in-hospital mortality rate than ETOH (-) patients [9.8% versus 16.6%; adjusted p=0.011; adjusted OR (95% CI)=0.39 (0.19,0.81)]. For brain-injured patients arriving alive to the hospital, ETOH intoxication is associated with a significantly lower incidence of early coagulopathy and in-hospital mortality. Further research to establish the pathophysiologic mechanisms underlying any potential beneficial effect of ETOH on the coagulation system following sTBI is warranted.
本研究旨在确定乙醇（ETOH）对严重创伤性脑损伤（sTBI）相关凝血障碍的影响，并探讨 ETOH 对 sTBI 患者住院期间结局的影响。回顾性分析 2005 年 6 月至 2008 年 12 月间因 sTBI 入住外科重症监护病房的患者，定义为头部损伤严重程度评分（AIS）≥3。排除胸部、腹部或四肢 AIS 评分>3 的患者，以尽量减少颅外损伤的影响。sTBI 相关凝血障碍的标准包括血小板减少症和/或国际标准化比值（INR）升高和/或活化部分凝血活酶时间（aPTT）延长。比较 ETOH 阳性（ETOH(+)）和 ETOH 阴性（ETOH(-)）患者的入院时凝血障碍、住院期间并发症和死亡率。在研究期间，有 439 名患者的 ETOH 水平可供分析。总体而言，46.5%（n=204）的患者 ETOH(+)，而 53.5%（n=235）的患者 ETOH(-)。与 ETOH(-)患者相比，ETOH(+)患者的凝血障碍发生率显著降低（5.4%对 15.3%；调整后 p<0.001）。在向前逐步逻辑回归分析中，ETOH 阳性水平被证明是入院时凝血障碍的独立保护因素[比值比（95%可信区间）=0.24（0.10，0.54；p=0.001]。与 ETOH(-)患者相比，ETOH(+)患者的住院死亡率显著降低[9.8%对 16.6%；调整后 p=0.011；调整后比值比（95%可信区间）=0.39（0.19，0.81）]。对于到达医院时存活的脑损伤患者，乙醇中毒与早期凝血障碍和住院死亡率显著降低相关。需要进一步研究以确定 ETOH 对 sTBI 后凝血系统潜在有益影响的病理生理机制。
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