A Study Of Significance Of Continuous Monitoring Of Hypercoagulability And The Effect Of Mild Hypothermia On It In Patients With STBI

Object: Significance of continuous monitoring of hypercoagulability and theeffect of mild hypothermia on it in patients with severe traumatic brain injury(sTBI) were studied.Methods: 40 patients with sTBI (GCS≤8') were divided into normalthermiacontrol group (NT, n=20) and mild hypothermia group (HT, n=20), which continuousmonitoring of hypercoagulability in all patients was performed for 72 hoursbeginning within 2～3 hours after injury. At the same time, Prothrombin time, (PT),Activated partial thromboplastin time (APTT), Thrombin time(TT), Fibrinogen(Fg),D—dimer(DD) levels in patients with sTBI were measured.The role of changesof hypercoagulability, the effect of mild hypothermia and factors which effect onit,and the relationship of hypercoagulability to outcome were analysed, and clinicaloutcomes were valued using the Glasgow Outcome Scale score(GOSs) at 3 monthsafter injury.Results: 1) PT, APTT, and TT in the NT group were shorter than in the HTgroup during the first 12 hours, and then increased after 12 hours, while PT, APTT, and TT in the HT group were longer during the first 12 hours, and returned to normallevels after 12 hours, there was significant difference between the two groups(p＜0.01). 2) Fg levels in the NT group were increased during the first 12 hours, anddecreased at 12 hours later, while Fg levels decreased in the first 12 hours andincreased after 12 hours in the HT group, there was significant difference betweentwo groups (p＜0.01). 3) DD levels in the NT group and HT group were increased,andthe maxium levels were monitored at the 12th hour.But the DD levels in the HTgroup decreased faster than in the NT group after 12 hours, there was significantdifference between the two groups (p＜0.01).4) The outcome was evaluated at 3months after injury. Outcome of HT was better than those of NT. there wassignificant difference between the two groups (p＜0.05).Conelusion: 1) The most sTBI patients were coagulopathy at the early stage,anddeveloped into hypercoagulability and secondary hyperfibrinolysis. The value ofcontinuous monitoring of hypercoagulability would affect sTBI patients' outcome. 2)Mild hypothermia therapy may improve the hypercoagulability of patientswith sTBI, and it can reduce the consumption of clotting factors,and inhibit thesecondary hyperfibrinolysis. 3) Continuous monitoring of hypercoagulability, whichis simple and safe, may be an important means of monitoring and guidingtreatment and evaluating prognosis in patients with sTBI.