重型颅脑损伤患者凝血纤溶标志物动态观察
Dynamic changes of coagulation and fibrinolysis markers in patients with severe craniocerebral trauma
摘要Objective To investigate the dynamic changes and the clinic significance of coagulation and fibrinolysis markers in patients with severe craniocerebral trauma. Methods Thirty three consecutive patients [Glasgow coma scale (GCS) ≦8 and APACHE II >10] including 10 women and 23 men with age of (46. 3 ± 16. 3) years old and with severe craniocerebral trauma were enrolled in this study. Endothelin(ET),alpha-granular membrane protein-140( GMP-140) and D-dimer(DD) were measured at 1st day ,3rd day and 7th day of admission, head computerized tomography (CT) was performed on each patient.Twenty healthy people with similar age were as control. ET was determined by the reagent kit which from Shanghai Shenjia company and GC-1200 -γ radiatory counter. GMP-140 was determined by the reagent kit which from Suzhou university and PEKINEINMER WIZARD-1470 γ radiatory counter. DD was determined by the reagent kit Shanghai sung biological product company limited and measured by latex agglutination.Results ET,GMP-140 and DD levels were significantly increased at the time of admission [(75. 24 ± 26. 44)pg/ml,(26.43 ± 13. 94) ng/ml, (3. 20 ± 0. 97) μg/ml, respectively ] ,then gradually decreased. ET and DD levels were significantly higher than control group even after 7 days[ (44. 66 ± 15. 25)pg/ml, (1. 35±0.55) μg/ml, respectively ], but not for GMP-140. All of the coagulation and fibrinolysis abnormalities markers were negatively correlated with GCS,P<0. 05. There were 18 survivors including 8 vegetables and 15 dead including 1 case suffered from disseminated intravascular coagulation (DIC) in this investigation.Conclusions Coagulation and fibrinolysis abnormalities markers were occurred at the very early stage in the patients with severe craniocerebral trauma. The levels of ET, GMP-140 and DD levels were negatively correlated with GCS.
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