中国实用神经疾病杂志
中國實用神經疾病雜誌
중국실용신경질병잡지
CHINESE JOURNAL OF PRACTICAL NERVOUS DISEASES
2015年
11期
10-11
,共2页
重型颅脑创伤%急性创伤性凝血病%亚低温%常温
重型顱腦創傷%急性創傷性凝血病%亞低溫%常溫
중형로뇌창상%급성창상성응혈병%아저온%상온
STBI%ATC%Mild hypothermia%Normal temperature
目的：观察亚低温与常温对重型颅脑创伤（severe traumatic brain injury ，sTBI）合并急性创伤性凝血病患者的影响。方法纳入70例sTBI合并急性创伤性凝血病患者，根据治疗方案的不同分组。对照组给予36.5～37.5℃常温状态下常规治疗，研究组在直肠温度（rectum temperature ，RT ）32.5～34.5℃的亚低温状态下常规治疗。对2组患者的血浆凝血酶原时间（prothrombin time ，PT）、活化部分凝血活酶时间（activated partial thromboplastin time ，APTT）、凝血酶时间（throm‐bin time ，TT）、血浆纤维蛋白原含量（fibrinogen ，Fg）、D‐二聚体（D‐dimer ，DD）等进行72 h监测，分析sTBI合并急性创伤性凝血病患者受伤后早期高凝状态的变化规律，对患者住院期间并发症情况进行统计。结果治疗前2组患者 PT、APTT、TT、Fg以及DD水平均无明显差异（P＞0.05）。治疗后研究组患者PT、APTT、TT、DD水平明显低于对照组（P＜0.05），Fg水平明显高于对照组（P＜0.05）。研究组迟发性血肿、纤溶亢进、脑梗死并发症发生率分别为8.57％、2.86％、0％，对照组迟发性血肿、纤溶亢进、脑梗死并发症发生率分别为5.71％、34.29％、25.71％，研究组并发症发生率低于对照组（ P＜0.05）。结论亚低温治疗sTBI合并急性创伤性凝血病，能够有效缓解患者高凝状况，减少凝血因子的消耗，进而抑制继发的纤溶亢进。
目的：觀察亞低溫與常溫對重型顱腦創傷（severe traumatic brain injury ，sTBI）閤併急性創傷性凝血病患者的影響。方法納入70例sTBI閤併急性創傷性凝血病患者，根據治療方案的不同分組。對照組給予36.5～37.5℃常溫狀態下常規治療，研究組在直腸溫度（rectum temperature ，RT ）32.5～34.5℃的亞低溫狀態下常規治療。對2組患者的血漿凝血酶原時間（prothrombin time ，PT）、活化部分凝血活酶時間（activated partial thromboplastin time ，APTT）、凝血酶時間（throm‐bin time ，TT）、血漿纖維蛋白原含量（fibrinogen ，Fg）、D‐二聚體（D‐dimer ，DD）等進行72 h鑑測，分析sTBI閤併急性創傷性凝血病患者受傷後早期高凝狀態的變化規律，對患者住院期間併髮癥情況進行統計。結果治療前2組患者 PT、APTT、TT、Fg以及DD水平均無明顯差異（P＞0.05）。治療後研究組患者PT、APTT、TT、DD水平明顯低于對照組（P＜0.05），Fg水平明顯高于對照組（P＜0.05）。研究組遲髮性血腫、纖溶亢進、腦梗死併髮癥髮生率分彆為8.57％、2.86％、0％，對照組遲髮性血腫、纖溶亢進、腦梗死併髮癥髮生率分彆為5.71％、34.29％、25.71％，研究組併髮癥髮生率低于對照組（ P＜0.05）。結論亞低溫治療sTBI閤併急性創傷性凝血病，能夠有效緩解患者高凝狀況，減少凝血因子的消耗，進而抑製繼髮的纖溶亢進。
목적：관찰아저온여상온대중형로뇌창상（severe traumatic brain injury ，sTBI）합병급성창상성응혈병환자적영향。방법납입70례sTBI합병급성창상성응혈병환자，근거치료방안적불동분조。대조조급여36.5～37.5℃상온상태하상규치료，연구조재직장온도（rectum temperature ，RT ）32.5～34.5℃적아저온상태하상규치료。대2조환자적혈장응혈매원시간（prothrombin time ，PT）、활화부분응혈활매시간（activated partial thromboplastin time ，APTT）、응혈매시간（throm‐bin time ，TT）、혈장섬유단백원함량（fibrinogen ，Fg）、D‐이취체（D‐dimer ，DD）등진행72 h감측，분석sTBI합병급성창상성응혈병환자수상후조기고응상태적변화규률，대환자주원기간병발증정황진행통계。결과치료전2조환자 PT、APTT、TT、Fg이급DD수평균무명현차이（P＞0.05）。치료후연구조환자PT、APTT、TT、DD수평명현저우대조조（P＜0.05），Fg수평명현고우대조조（P＜0.05）。연구조지발성혈종、섬용항진、뇌경사병발증발생솔분별위8.57％、2.86％、0％，대조조지발성혈종、섬용항진、뇌경사병발증발생솔분별위5.71％、34.29％、25.71％，연구조병발증발생솔저우대조조（ P＜0.05）。결론아저온치료sTBI합병급성창상성응혈병，능구유효완해환자고응상황，감소응혈인자적소모，진이억제계발적섬용항진。
Objective To observe the impact of mild hypothermia and normal temperature on patients with STBI combined ATC. Methods 70 patients with STBI combined ATC were chosen and were divided into groups according to different treat‐ment methods. Control group was given routine treatment under 36.5‐37.5 ℃ while study group was given routine treatment under mild hypothermia of rectum temperature of 32.5‐34.5 ℃. PT ,APTT ,TT ,Fg and DD of two groups were monitored for 72 hours. The changes of early stage after injury hypercoagulability of patients with STBI combined ATC were analyzed. Besides ,complications of patients during hospitalization were counted.Results Before treatment ,there were no significant differences between the two groups on PT ,APTT ,TT ,Fg and DD levels (P<0.05). After treatment ,PT ,APTT ,TT and DD levels of study group were obviously lower than control group (P<0.05) and Fg level was obviously higher than control group (P<0.05). Delayed hematoma ,hyperfibrinolysis and cerebral infarction of study group were separately accounted for 8.57% ,2.86% and 0 ,while those of control group were separately 5.71% ,34.29% and 25.71%. The rates of hyperfibrinol‐ysis and cerebral infarction of study group were lower than control group (P<0.05).Conclusion Mild hypothermia for pa‐tients with STBI combined ATC can effectively relieve hypercoagulability of patients and reduce consumption of blood coagula‐tion factor and thus inhibit secondary hyperfibrinolysis.
