Relationship Between Abnormal Coagulation Function And Severity、Prognosis In Traumatic Brain Injury

ObjectiveTo investgate the relationship of coagulation dysfunction and brain injury severity,and follow up the patients treatment outcome,to explore the impact of these factors on the prognosis and provide theoretical basis for diagnosis and treatment of traumatic brain injury.Methods106 cases in Guangshan County People’s Hospital department of neurosurgery patients with craniocerebral injury from March 2015 to June 2017 as the research object,on the basis of admission GCS score group of patients with GCS,which is less than or equal to 8 points for the severe group,9-15 were divided into mild to moderate group.The blood of the elbow vein was taken in 24 h,3D and 7d,and the indexes of PT,APTT and PLT were detected by automatic biochemical analyzer.In addition,thrombotic elastograph was used to detect coagulation reaction time(R),blood cell agglutination block formation time(K),blood cell agglutination block formation rate(a angle),blood clot maximum strength or hardness(MA),and Clotting Index(Cl).The CT examination was performed on 7d after the injury,respectively.The incidence of delayed intracranial hematoma was recorded.The incidence of delayed intracranial hematoma was recorded at 7d after the injury,and the brain CT examination was performed again after the injury.From the day of admission,the prognosis of the patients was evaluated 3 months later.The results were indicated by GOS score.The relationship between abnormal coagulation function and the severity and prognosis of the disease was compared.Results1.There were 38 cases with abnormal coagulation function in 106 patients,Amongthem,22 cases in severe group,16 cases in mild and moderate group.The difference between groups was statistically significant(P<0.05).There were 38 cases of abnormal coagulation function in 106 patients.The blood coagulation indexes of 24 h,3D and 7d at different time points after injury were compared.Compared with the immediate post injury,24 h and 3D PT and APTT increased after injury,but the difference was not statistically significant(P>0.05).In 7d after injury,the patients’ APTT and PLT were significantly higher,and the difference was statistically significant(P<0.05).2.A comparison of the specific detection values of a specific coagulation index is shown.PT,APTT and PLT counts were significantly increased in severe group(P<0.05).Follow up for 3 months,106 patients had good prognosis,78 cases(GOS 4 points,42 cases,5 cases 36 cases),of which 21 cases had abnormal coagulation function and 57 cases had normal coagulation function.There were 28 patients with poor prognosis(4 cases of GOS 1,10 in 2,14 in 3).There were 17 cases of abnormal coagulation function and 11 cases with normal coagulation function.There were statistical differences between groups(P<0.05).In comparison with specific coagulation indicators,PT,APTT and PLT count increased significantly(P<0.05).3.In 106 patients,the R time of thrombus and elasto map was compared to the patients with different severity.The R time in the severe group was significantly higher than that of the mild and moderate patients,and the difference was statistically significant(P<0.05).However,there was no significant difference in blood cell agglutination block formation time(K),blood cell agglutination block formation rate(a angle),blood clot maximum strength or hardness(MA),coagulation index(Cl)and other indicators(P>0.05).Follow up for 3 months,106 patients had good prognosis in 78 cases,and poor prognosis in 28 cases.The comparison between groups showed that R time in patients with good prognosis was significantly lower than that in patients with poor prognosis(P<0.05).The other indexes were not statistically significant(P>0.05).Conclusions1.The coagulation index of patients at different points in time after acute brain injury may change.the specific performance of PT,APTT,PLT count was significantly increased in severe group,but the FIB was reduce.Chanes in coagulation function in patients with craniocerebral injuryare closely related to the degree and prognosis of craniocerebral injuryare.It can be used as a reference index for disease assessment and prognosis judgment.2.The R time of Patients with severe craniocerebral injury are significantly longer than patients with mild or moderate injury,and the R time of patients with good prognosis is significantly shorter than that of those with poor prognosis.The R time can be used as a reference index for the evalution of acute brain and prognosis.