摘要
目的探讨血浆D-二聚体(D-D)动态变化对颅脑损伤后颅内进展性出血(PHI)以及预后的影响,评估D-D对急性颅脑损伤诊治过程中的辅助价值。方法选取滁州市第一人民医院神经外科2012年7月—2016年8月收治的88例急性颅脑损伤患者,分时段采集患者伤后24 h内、第3天、第7天、第15天外周静脉血,检测伤后血浆D-D动态变化;所有患者入院后24 h内、第3天、第7天以及第15天均行颅脑CT检查,根据CT检查结果分成2组,颅脑CT复查提示颅内血肿较前明显增大者(≥25%)为PHI组,未明显增大者为对照组。进一步进行临床资料分析研究,分析D-D对颅脑损伤程度、PHI及预后的影响。结果 88例颅脑损伤患者中,有42例为PHI患者,发生率为47.73%。PHI患者伤后24 h内、第3天、第7天、第15天外周静脉血D-D含量均显著高于非PHI患者(24 h内:7.47±6.35 vs.2.01±2.46;第3天:4.06±3.43 vs.1.41±2.37;第7天:2.73±3.03 vs.0.91±1.38;第15天:1.77±3.15 vs.0.41±1.07,均P<0.05);GCS评分≤8分患者D-D含量明显较高,GCS≥9分患者D-D含量较低,2组差异有统计学意义(P<0.05);死亡患者血浆D-D水平明显高于非死亡患者,2组差异有统计学意义(P<0.05)。分析结果显示,D-D含量较高者,PHI发生率亦较高;预后不同的患者D-D含量有显著差异。结论急性颅脑损伤中D-D含量异常增高,可作为PHI发生的预测因素,是判断患者伤情及预后的重要指标,有较高临床价值。
Objective To investigate the dynamic changes of plasma D-dimer （D-D） level in patients iwht intracranial progressive hemorrhagic injury（PHI） after traumatic brain injury, and evaluate its auxiliary value in process of diagnosis and treatment of acute traumatic brain injury, and the influence on the prognosis. Methods Eighty-eight patients with acute eraniocerebral injury in our hospital from July, 2012 to August, 2016 were enrolled. On 24 h, d l, d7 and d15, the peripheral venous blood was prepared for the test of D-D levels, and CT was performed in all patients, and according to the CT findings,the patients were divided into control group and PHI group（ the intracranial hematoma increased significantly, ≥25% ）. The influence of D-D level on the degree of brain injury and prognosis was analyzed combined with the clinical data. Results Of the 88 patients ,42 were with PHI（47.73% ）. The levels of DD in peripheral venous blood were significantly higher than those in the control group [ 24 hours, （ 7.47 ± 6.35 ） ： （ 2.01 ± 2.46 ） ], [ 3 days, （ 4.06 ±3.43 ） ： （1.41±2.37）],[7 days,（2.73±3.03）：（0.91±1.38）],[15 days,（1.77±3.15）：（0.41±1.07）],P〈0.05. GCS ≤8 points in patients with D-D level was significantly higher, GCS ≥9 points in patients with low D-D level, the two groups were significantly different;The plasma D-D level was significantly higher in the death group than in the non-death group （P 〈 0.05 ）. The results showed that the higher the D-D level, PHI incidence was also higher;the prognosis of patients with different D-D level was significantly different. Conclusion The abnormal increase of D-D level in patients with acute brain injury can be used as a predictive factor of PHI, and is an important index to judge the injury and prognosis of patients.
出处
《中华全科医学》
2017年第7期1123-1126,共4页
Chinese Journal of General Practice
基金
安徽省科技攻关计划(1604a0802092)
