颅脑损伤患者创伤后凝血病发生的影响因素分析

摘要

目的：分析颅脑损伤患者创伤后凝血病发生的危险因素。方法选取2014年6月～2015年10月接受治疗的115例颅脑损伤患者为观察对象，根据其是否发生凝血病分为凝血病组和非凝血病组。观察颅脑损伤患者创伤后凝血病的发生率，分析造成创伤后凝血病发生的危险因素。结果115例颅脑损伤患者中，发生创伤后凝血病26例，凝血病发生率为22．61％；凝血病组患者凝血酶原时间（ PT）、活化部分凝血酶原时间（PTT）和血小板计数（PLT）水平低于非凝血病组，D－二聚体（D－DT）水平高于非凝血病组，两组患者的纤维蛋白原（FIB）水平无明显差异（P＞0．05）；损伤严重度评分（ISS）＞16分、血压≤90mmHg、体温＜36．5℃、动脉血pH＜7．2的颅脑损伤患者创伤后凝血病的发生率较高，差异具有统计学意义，而不同年龄、性别的患者凝血病发生率无明显差异；将单因素分析有意义的ISS评分＞16分、收缩压≤90mmHg、体温＜36．5℃、动脉血pH＜7．2作为自变量，将是否发生凝血病作为因变量，进行多因素Logistic回归分析，结果ISS评分、输液量和动脉血pH进入回归方程，其OR值分别为4．286、5．128和3．962。结论颅脑损伤患者有发生创伤后凝血病的危险，ISS评分、输液量和动脉血pH是患者发生凝血病的危险因素。%Objective To analyze the risk factors of blood coagulation in patients with traumatic brain inju-ry.Methods Totally 115 cases of traumatic brain injury in our hospital from Jun.2014 to Oct.2015 were select-ed as the observation objects.According to the occurrence of coagulation disorders,they were divided into the coagu-lation group and the non-coagulation group.The incidence of post-traumatic coagulation in patients with traumatic brain injury was observed,and the risk factors for the occurrence of post-traumatic coagulation disorders were ana-lyzed.Results Among the 115 patients with traumatic brain injury,26 cases developed post-traumatic coagulation disor-ders, and the incidence of coagulation was 22.61%.The levels of PT,PTT and PLT in patients in the coagulation group were lower than those in the non-coagulation group,and the level of D-DT was higher than that in the non-coagulation group,and there was no significant difference in the level of FIB between the two groups(P>0.05).Patients with ISS>16 points,arterial blood pressure≤90 mmHg;temperature <36.5 degrees,blood pH<7.2 had higher coagulation occur-rence rate,and the difference was statistically significant.Significant factors according to the single factor analysis such as ISS>16 points,blood pressure ≤90mmHg, temperature <36.5 degrees,and arterial blood pH<7.2 were set as inde-pendent variables,while coagulation as dependent variables for multivariate logistic regression analysis.Results showed that ISS, transfusion and arterial blood pH entered into the regression equation,and the OR value were 4.286,512.8 and 3.962,respectively.Conclusion Patients with traumatic brain injury have the risk of post-traumatic coagulation.The degree of brain injury,fluid infusion and arterial blood pH are risk factors for the occurrence of coagulation.