本文選題：顱腦損傷 + 凝血　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:顱腦損傷(traumatic brain injury,TBI)是神經(jīng)外科、創(chuàng)傷醫(yī)學(xué)常見(jiàn)疾病,無(wú)論是發(fā)病率、致殘率還是死亡率都較高。顱腦損傷后往往伴隨著凝血功能的變化,尤其中重型顱腦損傷。近年來(lái)顱腦損傷后凝血功能的變化越來(lái)越引起創(chuàng)傷醫(yī)學(xué)和神經(jīng)外科界的關(guān)注。本課題通過(guò)監(jiān)測(cè)中重型顱腦損傷后凝血指標(biāo)變化,研究顱腦損傷患者病情是否與凝血指標(biāo)存在一定的關(guān)聯(lián)性,并探討凝血指標(biāo)、DIC評(píng)分對(duì)預(yù)后的判斷。方法:收集74例山西醫(yī)科大學(xué)附屬山西大醫(yī)院神經(jīng)外科2016年1月-2016年6月中重型顱腦創(chuàng)傷(24h內(nèi)入院,GCS評(píng)分小于等于12分)患者的住院病例,根據(jù)GCS(Glasgow Coma Score)評(píng)分,分為中型顱腦損傷(29例),重型顱腦損傷(45例)。并收集來(lái)山西大醫(yī)院行健康體檢的20名社會(huì)人員為對(duì)照組。顱腦損傷的患者均在受傷后24小時(shí)內(nèi)行凝血指標(biāo)與血小板計(jì)數(shù)檢驗(yàn)。進(jìn)入最后統(tǒng)計(jì)74例病例均排除了以下情況:顱腦損傷合并重要臟器嚴(yán)重?fù)p傷或衰竭者;既往有肝病、糖尿病、血液病等可能影響凝血功能的患者;血標(biāo)本采集之前,給與輸注全血或血制品的患者;血標(biāo)本采集之前,給予急診手術(shù)者;血標(biāo)本采集之前,使用影響凝血功能的食物或藥物患者。根據(jù)凝血指標(biāo)與血小板計(jì)數(shù)計(jì)算出DIC評(píng)分,以了解凝血指標(biāo)及DIC評(píng)分與顱腦損傷輕重的關(guān)系。對(duì)所有患者在創(chuàng)傷后6個(gè)月進(jìn)行病情隨訪,并根據(jù)隨訪結(jié)果按格拉斯哥預(yù)后分級(jí)(Glasgowoutcomescale,GOS)分組:分為預(yù)后良好組(4-5分),預(yù)后不良組(1-3分)。對(duì)收集的樣本進(jìn)行統(tǒng)計(jì)學(xué)分析,應(yīng)用SPSS17.0統(tǒng)計(jì)軟件處理數(shù)據(jù),全部計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差(mean±standard deviation)表示,各組間采用t檢驗(yàn)、p0.05為有統(tǒng)計(jì)學(xué)意義,并行ROC曲線,計(jì)算曲線下面積。結(jié)果:顱腦損傷后很容易引起凝血功能的變化,本研究中重型顱腦損傷患者中,凝血功能異�？傮w發(fā)生率為86.5%,其中中型、重型顱腦損傷凝血異常發(fā)生率分別為79.3%、91.1%。根據(jù)GCS評(píng)分分組,其中凝血指標(biāo)PT、TT、Fib、D-二聚體顯著變化,并具有統(tǒng)計(jì)學(xué)意義;而凝血指標(biāo)APTT、AT-Ⅲ、血小板變化無(wú)統(tǒng)計(jì)學(xué)意義。根據(jù)GOS評(píng)分分組,其中PT、D-二聚體、DIC評(píng)分有顯著變化,并具有統(tǒng)計(jì)學(xué)意義,而TT、APTT、AT-Ⅲ、Fib、血小板變化無(wú)統(tǒng)計(jì)學(xué)意義。根據(jù)ROC曲線,計(jì)算得出PT、D-二聚體、DIC評(píng)分的面積為分別為:0.693、0.646、0.779。結(jié)論1.中重型顱腦損傷后,患者廣泛存在凝血功能異常。2.中重型顱腦損傷患者中,損傷越重,凝血功能異常發(fā)生率越高,凝血指標(biāo)變化幅度越大。3.PT、D-二聚體、DIC評(píng)分能夠?qū)︻A(yù)后做出一定的判斷;根據(jù)ROC曲線,DIC評(píng)分較PT、D-二聚體對(duì)預(yù)后判斷更準(zhǔn)確、更可靠。
[Abstract]:Objective: traumatic brain injury-tibi (TBI) is a common disease in trauma medicine, which has a high morbidity, disability rate and mortality rate. After craniocerebral injury, coagulation function changes, especially severe craniocerebral injury. In recent years, the changes of coagulation function after craniocerebral injury have attracted more and more attention in trauma medicine and neurosurgery. By monitoring the changes of coagulation indexes after moderate and severe craniocerebral injury, this paper studies whether the condition of patients with craniocerebral injury is related to coagulation indexes, and probes into the prognostic value of coagulation index (DIC). Methods: a total of 74 hospitalized patients with severe craniocerebral trauma (GCS(Glasgow Coma score < 12) in neurosurgery Department of Shanxi Medical University affiliated to Shanxi Medical University from January 2016 to June 2016 were collected. There were 29 cases of moderate craniocerebral injury and 45 cases of severe craniocerebral injury. And collect 20 social personnel that come to Shanxi big hospital to carry out health check-up as control group. Patients with craniocerebral injury were examined for coagulation and platelet count within 24 hours after injury. In the final count of 74 cases, the following conditions were excluded: patients with craniocerebral injury complicated with severe injury or failure of important organs; patients with liver disease, diabetes mellitus, hematologic diseases, etc., who may affect coagulation function; before blood samples were collected, A patient who infuses whole blood or blood products; who is given emergency surgery before the collection of blood samples; and who uses food or drugs that affect the clotting function before the collection of blood samples. DIC score was calculated according to coagulation index and platelet count in order to understand the relationship between coagulation index and DIC score and the severity of craniocerebral injury. All patients were followed up 6 months after trauma. According to the results of follow-up, Glasgow outcomer scale GOS was divided into four groups: good prognosis group (4-5 points) and poor prognosis group (1-3 points). The collected samples were analyzed statistically, and the data were processed by SPSS17.0 statistical software. All the measurement data were expressed as mean 鹵standard deviation (mean 鹵standard deviation). The t test was used to calculate the area under the curve. Results: it was easy to change the coagulation function after craniocerebral injury. The total incidence of abnormal coagulation function was 86.5 in the patients with moderate and severe craniocerebral injury. The abnormal rate of coagulation in type and severe craniocerebral injury was 79.3% and 91.1%, respectively. According to the GCS score group, the coagulation index PTT TTB D dimer was significantly changed with statistical significance, but the coagulation index APTTT AT- 鈪，

本文編號(hào)：1900408