Takanashi Y, Shinonaga M, Koh E, Naitoh M, Yamamoto I
Division of Neurosurgery, Hiratsuka Kyosai Hospital, Kanagawa, Japan.
No To Shinkei. 1996 Nov;48(11):1009-13.
To identify early prognostic value of brain injury, a comparison was made between computerized tomography (CT) findings, coagulation abnormalities, and clinical features in 51 patients with closed head injury. The patients were divided into three groups according to their plasma level of fibrin-fibrinogen degradation product (FDP): normal group (FDP 10 micrograms/ml or less) in 20 patients; moderately abnormal group (FDP 10-40 micrograms/ml) in 15 patients; and highly abnormal group (FDP 40 micrograms/ ml or more) in 16 patients. Cases with a fatal clinical course were mostly associated with very high FDP level. Mortality rate in the highly abnormal group was 44% and 7% in the moderately abnormal group were dead cases, while no cases in the normal group turned out poor outcome. Injury severity, as assessed by Glasgow Coma Scale (GCS) score, correlated with the increase of plasma FDP level. Although severe head injury (GCS 8 or less) was found in 44% of the highly abnormal group and 13% of the moderately abnormal group, normal group only had one case (5%). Very high FDP concentrations were found to be associated with combined hemorrhagic lesions and mass effect on CT scan, but not with a specific localization of brain damage. In summary, the evaluation of coagulation and fibrinolytic function in patients following closed head injury might have both diagnostic and prognostic value.
为了确定脑损伤的早期预后价值，对51例闭合性颅脑损伤患者的计算机断层扫描（CT）结果、凝血异常和临床特征进行了比较。根据血浆纤维蛋白-纤维蛋白原降解产物（FDP）水平将患者分为三组：正常组（FDP 10微克/毫升或更低）20例；中度异常组（FDP 10 - 40微克/毫升）15例；高度异常组（FDP 40微克/毫升或更高）16例。临床病程致命的病例大多与FDP水平极高有关。高度异常组的死亡率为44%，中度异常组有7%的病例死亡，而正常组无病例预后不良。根据格拉斯哥昏迷量表（GCS）评分评估的损伤严重程度与血浆FDP水平的升高相关。虽然高度异常组44%的患者和中度异常组13%的患者存在严重颅脑损伤（GCS 8分或更低），但正常组仅有1例（5%）。CT扫描显示，FDP浓度极高与出血性病变合并占位效应有关，但与脑损伤的特定定位无关。总之，对闭合性颅脑损伤患者的凝血和纤溶功能进行评估可能具有诊断和预后价值。
