Wang JUNQIN,Jin Wen.Relationship between changes of coagulation function,disease progression and prognosis after acute traumatic brain injury in children[J].Journal of Clinical Pediatric Surgery,2023,22(02):149-153.[doi:10.3760/cma.j.cn101785-202202018-010]
儿童急性创伤性脑损伤后凝血功能变化与病情进展及短期预后的关系探讨
- Title:
- Relationship between changes of coagulation function,disease progression and prognosis after acute traumatic brain injury in children
- Keywords:
- Brain Injuries; Traumatic; Blood Coagulation; Prognosis; Correlation of Data; Child
- 摘要:
- 目的 探讨儿童急性创伤性脑损伤后凝血功能变化及其与病情进展及短期预后的关系。 方法 回顾性分析山西省儿童医院神经外科2020年3月至2021年3月收治的389例急性创伤性脑损伤患儿临床资料,收集所有患儿入院时凝血功能指标、脑损伤严重程度、出院后6个月随访情况以及格拉斯哥预后评分(Glasgow Outcome Scale,GOS评分)情况,并采取Logistic回归分析患儿入院时凝血指标与脑损伤严重程度及GOS评分情况之间的关系。 结果 重型、中型及轻型创伤性脑损伤患儿年龄分别为2.50 (1.08,4.50)岁、3.00(0.90,4.00)岁、4.00(2.00,6.50)岁,差异有统计学意义(H=11.640,P＝0.003);CT表现异常人数分别为28例、64例、237例,差异有统计学意义(χ2=9.815,P＝0.007);手术治疗人数分别为14例、63例、280例,差异有统计学意义(χ2=9.815,P＝0.007);凝血酶原时间(prothrombin time, PT)(P＜0.001)、国际标准化比值(international normalized ratio, INR)(P＜0.001)、纤维蛋白原(fibrinogen, FIB)(P＝0.029)、凝血活酶时间(activated partial thromboplastin time,APTT)(P＝0.015)、D-二聚体(D-dimer,D-d)(P＜0.001)、血小板(Platelets, PLT)(P＝0.001)及纤维蛋白降解产物(fibrin/fibrinogen degradation product, FDP)(P＜0.001)比较,差异均有统计学意义(P<0.05)。出院后6个月随访,损伤程度与GOS评分之间呈显著负相关(r=-0.666,P＜0.05)。不同预后的急性创伤性脑损伤患儿INR、PLT、PT、FIB、凝血酶时间(thromboplastintime, TT)、D-d、FDP值比较,差异均有统计学意义(P＜0.05)。 结论 儿童创伤性脑损伤后可能存在凝血功能异常,且损伤越严重,凝血功能异常越明显,短期预后越差;凝血功能指标可为评估预后及尽早实施临床干预提供依据。
- Abstract:
- Objective To explore the relationship between coagulation parameters,disease progression and short-term prognoses in children with acute traumatic brain injury.Methods From March 2020 to March 2021,clinical data were retrospectively reviewed for 389 children with acute traumatic brain injury.Coagulation parameters,severity of brain injury and Glasgow Outcome Scale (GOS) of all children were collected at admission.And the relationship between changes of coagulation parameters,severity of brain injury and GOS was analyzed by Logistic regression.Results Age,computed tomography (CT) manifestations and treatments methods among children with different degrees of traumatic brain injury were significantly different (P<0.05).The differences of prothrombin time (PT),international normalized ratio (INR),fibrinogen (FIB),thrombin time (APTT),D-dimer (D-D),platelet (PLT) and fibrin degradation product (FDP) in mild,moderate and severe traumatic brain injury were statistically significant (P<0.05).During a follow-up period of 6 months,a significant negative correlation existed between injury severity and GOS (r=0.666,P<0.05).The values of INR,PLT,PT,FIB,thromboplastin time (TT),D-d and FDP were prolonged in children with acute traumatic brain injury with different prognoses.Conclusion Coagulation dysfunctions exist in children after traumatic brain injury.The more serious the injury the more obvious abnormal blood coagulation and the worse the prognosis.Blood coagulation parameters provide rationales for evaluating prognoses and offering clinical interventions as soon as possible.
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备注/Memo
收稿日期:2021-8-12。
通讯作者:靳文,Email:jinwen1970@sina.com