The Significance Of Early Dynamic Monitoring Of Coagulation In Patients With Closed Craniocerebral Injury

Objective:To explore the variation of coagulation and fibrinolytic system, and the relationship between the variation and the degree and prognosis of traumatic brain injury (TBI) by dynamic monitoring the early changes of coagulation and fibrinolytic system in patients with the simple closed head injury.Methods:48 patients with the simple closed head injury were selected according to the inclusion criteria of experimental design. Among them 29 patients were male and 19 cases were female, the age was 18～62 years and the mean age was 34.2±12.1 years. 20 healthy adults aged 18 to 59 years old were in control group,12 males and 8 females among them and the average age was 32.3±10.1 years. The head injury patients were divided into mild (B), moderate (C) and severe group (D) according to admission Glasgow Coma Score (GCS), among which 9 patients with GCS 9～12 points in the B group,28 patients with GCS 6～8 points in the C group and 11 cases with GCS 3～5 points in the D group.20 healthy persons were selected as controls (A group). The level of PT, APTT, PTT, FDP and DD in each group was measured at 4h, 12h,24h,48h and 72h after TBI. The prognosis of all patients was assessed according to the Oxford Handicap Score (OHS) after 1 month of treatment, and was divided into death group, good prognosis group and poor prognosis group. The level of PT, APTT, PTT, FDP and DD were compared between the groups.Results:1. PT values prolonged at 4～48h after TBI, peaked at 12h, and decreased to the normal range after 72h in all brain injury groups. Compared with the A group, the PT values of C, D group at 4h,12h,24h, and 48h had a significant difference (P<0.01). The PT values of B, C, and D group at the different time points, except 72h, had a statistical difference (P<0.05). Compared with B, C group, the PT values of D group prolonged more significantly, and had statistically significant difference at 12h, 24h, and 48h (P<0.05).2. APTT values of all the head injury groups prolonged significantly, reached a peak at 12h after TBI, and then decreased. Compared with the A group, the APTT values of C, D group at 4h,12h,24h, and 48h had a significant difference (P<0.01). The PT values of B, C, and D group at the different time points had no statistical difference (P>0.05).3. PTT values of all the head injured patients prolonged early after injured, the values were higher significantly than the normal, and reached a peak at 12h after injured. Compared with the A group, the PTT values of B, C, D group prolonged significantly, and the difference between them was significant at 12h,24h, and 48h (P<0.01). Compared with the B group, the PTT values of C, D group had a statistical difference (P<0.05), and the PTT values, between C and D group at all time points, had no statistical difference (P>0.05).4. FDP values increased rapidly at 4-12h after injured, and reached the peak at 24h. The FDP values of B, C, D group at different time points had a statistical difference (P<0.05). Compared with the A group, the FDP values of B, C, D group at different time points increased significantly, and the difference was significant (P<0.01). The FDP values of B, C, and D group at the different time points had a significant difference (P<0.01).5. The DD level of the head injured patients increased significantly, reached a peak at 4h after injured, and then decreased, but the values of all injury groups remained higher than normal levels. The DD level of B, C, D group at different time points had a statistical difference (P<0.05). Compared with the A group, the DD values of B, C, D group at different time points increased significantly, and the difference was significant (P<0.01).6. The prognostic assessment showed that PT, APTT, PTT, FDP and DD of the patients in death group and poor prognosis group were significantly increased at 4h after injured, which had a significant difference compared with good prognosis group (P<0.01). Compared with death group and poor prognosis group, the APTT and PTT values at 4h after injured had no statistical difference (P>0.05).Conclusions:1. Coagulopathy can occur in the brain injured patients immediately after injured. Various types of TBI can lead to dysfunction of coagulation and fibrinolytic system, and its incidence of the patients in medium and severe TBI was more higher. 2. PT, APTT, PTT, FDP, and DD levels in the plasma of the brain injured patients were significantly higher than the normal control group, then PT, APTT, and PTT levels decreased gradually, and to almost normal levels at 72h after injured, but FDP and DD content remained at a high level at 72h after injured, which indicated that the early changes of coagulation in the brain injured patients was obvious, manifested as the activation of blood coagulation and fibrinolytic systems, and followed by secondary hyperfibrinolysis mainly. All these showed that the PT, APTT, PTT, FDP, and DD changes were related to the time after injury and the evolution of injury.3. PT, FDP, and DD levels in the plasma of medium and severe traumatic brain injured patients increased more obviously than in patients with mild head injury, which indicated that the changes of PT, FDP, and DD level were related to injury severity and consistent with the clinical assessment of TBI.4. PT, APTT, PTT, FDP, and DD levels in the plasma of poor prognosis group and death group, when admitted to hospital, were higher than good prognosis group, which showed that the early detection of coagulation and fibrinolytic indicators had some clinical value to the judgment of prognosis. PT, FDP, and DD were more accurate to the judgment of death and poor prognosis.