颅脑损伤急性期凝血与纤溶系统变化的临床意义

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1、目录中文摘要··········································································1英文摘要··········································································3正文················································································5引言················

2、································································5材料和方法·······································································8结果··············································································12讨论···································

3、···········································20结论··············································································27参考文献········································································28附表······················································

4、························30缩写词中英文对照表·························································31致谢··············································································32综述··············································································331万方

5、数据颅脑损伤急性期凝血及纤溶系统变化的临床意义中文摘要【目的】本研究通过对急性颅脑损伤患者的观察，探讨颅脑损伤后凝血、纤溶功能的变化趋势及其临床意义，研究其与颅脑损伤严重程度(GCS)及预后(GOS)之间的关系，并观察血浆PT，APTT，TT，Fbg，FDP以及D-二聚体(D-dimer,D-D)含量对迟发性外伤性颅内血肿(delayedtraumaticintracerebralhematoma,DTIH)和脑内血肿扩大的影响。【方法】采用发色底物法和乳胶免疫比浊法对50例急性颅脑损伤患者于伤后4、8、16、24、

6、36、48、72小时分别测定血浆PT，APTT，TT，Fbg，FDP和D-二聚体含量，并与20例正常对照组进行比较；再按伤情轻重、转归及迟发性颅内血肿形成与否等进行组间比较，应用统计软件SPSS(17.0版)对相关数据进行统计学处理及分析。【结果】1.颅脑损伤后各时间点FDP、D-D测定值与正常对照组相比均有显著性差异(P＜0.5)。颅脑损伤后各时间点的APTT、Fbg、PT、TT测定值与正常对照组相比不全有显著性差异(P＞0.05)。2.GCS≤8分组FDP、D-D伤后各时间点均明显高于GCS＞8分组，两组相比有显

7、著性差异(P＜0.05)。GCS≤8分组APTT、Fbg、PT、TT各时间点测定值与GCS＞8分组相比不全有显著性差异(P＞0.05)。3.DTIH组FDP、D-D伤后各时间点均明显高于Non-DTIH组，两组相比有显著性差异(P＜0.05)。预后不良组FDP、D-D伤后各时间点均明显高于预后良好组，两组相比有显著性差异(P＜0.05)。DTIH组PT、APTT、TT、Fbg各时间点测定值与Non-DTIH组相比不全有显著性差异(P＞0.05)，预后不良组APTT、Fbg、PT、TT各时间点测定值与预后良好组相比不全

8、有显著性差异(P＞0.05)。【结论】1、颅脑损伤急性期患者存在凝血指标异常。伤后4h即表现为血液高凝状态，伤后8h已由高凝状态进入继发性纤溶亢进阶段，直到伤后72h，仍然存在纤溶亢进现象。1万方数据2、颅脑损伤后的凝血功能障碍与患者的伤情轻重相关，颅脑损伤程度越重，凝血功能紊乱表现越明显。凝血紊乱对患者病情预后具有一定的评估价值。3、血浆FD