严重创伤性脑损伤后凝血功能障碍患者的治疗性低温。
Therapeutic hypothermia in patients with coagulopathy following severe traumatic brain injury.
机构信息
Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan.
Department of Emergency, Disaster and Critical Care Medicine, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan.
出版信息
Scand J Trauma Resusc Emerg Med. 2017 Dec 20;25(1):120. doi: 10.1186/s13049-017-0465-y.
BACKGROUND
Coagulopathy in traumatic brain injury (TBI) has been associated with poor neurological outcomes and higher in-hospital mortality. In general principle of trauma management, hypothermia should be prevented as it directly worsens coagulopathy. Therefore, we examined the safety of mild therapeutic hypothermia (MTH) in patients with coagulopathy following severe TBI.
METHODS
We re-evaluated the brain hypothermia (B-HYPO) study data based on coagulopathy and compared the Glasgow Outcome Scale scores and survival rates at 6 months using per protocol analyses. Coagulopathy was defined as an activated partial thromboplastin time (APTT) > 60 s and/or fibrin/fibrinogen degradation product levels (FDP) > 90 μg/mL on admission. Baseline characteristics, coagulation parameters, and outcomes were compared between the control and MTH groups with or without coagulopathy.
RESULTS
In patients with coagulopathy, 12 patients were allocated to the control group (35.5-37.0 °C) and 20 patients to the MTH group (32-34 °C). In patients without coagulopathy, 28 were allocated to the control group and 59 patients were allocated to the MTH group. In patients with coagulopathy, favorable neurological outcomes and survival rates were comparable between the control and MTH groups (33.3% vs. 35.0%, P = 1.00; 50.0% vs. 60.0%, P = 0.72) with no difference in complication rates. On admission, no significant differences in APTT or FDP levels were observed between the two groups; however, APTT was significantly prolonged in the MTH group compared to the control group on day 3.
DISCUSSION
Based on our study, MTH did not seem to negatively affect the outcomes in patients with coagulopathy following severe TBI on admission; therefore, the present study indicates that MTH may be applicable even in patients with severe TBI and coagulopathy.
CONCLUSIONS
Our study suggests that in comparison to control, MTH does not worsen the outcome of patients with coagulopathy following severe TBI.
TRIAL REGISTRATION
UMIN-CTR, No. C000000231 , Registered 13 September 2005.
背景
创伤性脑损伤（TBI）中的凝血功能障碍与不良神经结局和更高的院内死亡率相关。在创伤管理的一般原则中，应防止体温过低，因为它会直接使凝血功能障碍恶化。因此，我们研究了轻度治疗性低温（MTH）在严重 TBI 后伴有凝血功能障碍的患者中的安全性。
方法
我们根据凝血功能障碍重新评估了脑低温（B-HYPO）研究的数据，并使用方案分析比较了 6 个月时的格拉斯哥结局量表评分和生存率。凝血功能障碍定义为入院时活化部分凝血活酶时间（APTT）>60s 和/或纤维蛋白/纤维蛋白原降解产物水平（FDP）>90μg/mL。在有或没有凝血功能障碍的情况下，比较了对照组和 MTH 组之间的基线特征、凝血参数和结局。
结果
在有凝血功能障碍的患者中，12 例患者被分配到对照组（35.5-37.0°C），20 例患者被分配到 MTH 组（32-34°C）。在没有凝血功能障碍的患者中，28 例患者被分配到对照组，59 例患者被分配到 MTH 组。在有凝血功能障碍的患者中，对照组和 MTH 组的神经功能结局和生存率相当（33.3%对 35.0%，P=1.00；50.0%对 60.0%，P=0.72），并发症发生率无差异。入院时，两组间 APTT 或 FDP 水平无显著差异；然而，与对照组相比，MTH 组在第 3 天的 APTT 明显延长。
讨论
根据我们的研究，在入院时伴有凝血功能障碍的严重 TBI 患者中，MTH 似乎不会对结局产生负面影响；因此，本研究表明，MTH 可能适用于严重 TBI 合并凝血功能障碍的患者。
结论
我们的研究表明，与对照组相比，MTH 不会使严重 TBI 后伴有凝血功能障碍的患者的结局恶化。
试验注册
UMIN-CTR，编号 C000000231，注册于 2005 年 9 月 13 日。
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