Sub-hypothermia Therapy And The Change Of The Coagulation In Severe Head Injury

Objective:We observed the change of coagulation and fibrinolysis assays of the patients with severe head injury accepted sub-hypothermia therapy, and tried to analyze the relationship between this change and the patients' condition and prognosis.Materials and methods:1.Patients' information43 patients(30males and 13 females) enrolled in this study according the designed inclusion criteria and exclusion criteria.43 cases were divided into two groups randomly by taking lot according to gender when admitted:group A was sub-hypothermia group and group B was control group.20 cases(13 males and 7 females) enrolled into group A, whose age range from 16 to 66 years old,average 37.05±15.67 years.23 cases enrolled into group B,whose age range from 18 to 61 years old, average 38.96±14.18 years.The patients in two groups had not significant difference in the gender and age(P=0.381,P=0.632). According;to the GCS score,there was not significant difference between the 20 patients of group A(7 cases GCS range 3-5 and 13 cases range GCS 6-8) and other 23 patients of group B(8 cases range GCS 3-5 and 15 cases range GCS 6-8)(P=0.619).Patients of two groups accept same conventional therapy for severe head injury.Patients of group A admitted into sub-hypothermia treatment unit immediately with incision of trachea or tracheal intubation,assisted respiration or controlled respiration by breathing machine and reduced the body temperature to 32.0℃-35.0℃by ice blanket,ice cap and ice cubes.Hibernation and muscle relaxant composition(aminazine 100mg+ promethazine 100mg+tracium 200-400mg+normal sodium 500ml) given at same time in order to reduce shakes.Patients of group B accepted generality cooling measure only to keep body temperature about 37.0℃.1.8ml blood samples were obtained from ulnar vein of every patient in five time(6h,12h,24h,48h and 72h post head trauma) respectively.The laboratory examination included:Fbg,FDP,D-dimmer,t-PA,PAI-1 and AT-Ⅲ.2.Statistical methods:we used SPSS11.5 software package for statistical analysis.The numerical value expressed as(?)±s.The methods include One-Way ANOVA,general linear models test and x~2 test. Significance was set at P＜0.05.Results:1.Fbg According general linear models test,Fbg level had significant difference between two groups(F=7.105,P=0.011).Fbg level was higher in sub-hypothermia group than that in control group.The detection at different times had significant difference(F=91.692,P=0.000).Treatment and time had interaction(F=14.452,P=0.000).When analyzing the solo effects,Fbg level had significant difference between two groups at 6h,12 h,24 h and 48 h respectively(P=0.003,P=0.000,P=0.000,P=0.024) and Fbg difference was significant among each time in a same group (P=0.000).2.FDPAccording general linear models test,FDP level was lower in sub-hypothermia group and had significant difference between two groups(F=5.033,P=0.030).The detection at different time had significant difference in same group(F=8.998,P=0.000).But the therapy and time had not interaction(F=1.788,P=0.134).It means the tendency of FDP had not difference between two different therapy groups.3.D-dimerAccording general linear models test,although D-dimer level was lower in sub-hypothermia group than that in control group,it had significant difference between two groups(F=5.540,P=0.023).The difference was significant at different times post trauma in same group (F=51.690,P=0.000).With time prolongation,the sub-hypothermia therapy and time had interaction(F=5.419,P=0.000).It means the change tendency of D-dimer had difference between two different therapy groups.When analyzing the solo effects,D-dimer level had significant difference between two groups at 6h,12h and 24h respectively(P=0.002,P=0.026,P=0.020) and didn't have difference at 48h and 72h respectively(P=0.378,P=0.247).D-dimer difference was significant among each time in a same group(P=0.000).4.t-PAAccording general linear models test,the t-PA level was lower in the patients of group A than group B,it had significant difference between two groups(F=51.690,P=0.000).The difference was significant among t-PA levels at different post-trauma time in a same group (F=85.053,P=0.000).With time prolongation,the therapy and the time had not interaction(F=0.688,P=0.601).It means the change tendency of t-PA had not difference between different therapy groups.5.PAI-1According general linear models test,PAI-1 level had not significant difference between patients of group A and group B(F=2.787,P=0.103) and had significant difference at different time in a same group (F=55.406,P=0.000).With time prolongation,the therapy and time had not interaction(F=0.605,P=0.660).It means the change tendency of PAI-1 had not difference between different therapy groups. 6.AT-ⅢAccording general linear models test,AT-Ⅲactivity had not significant difference between two group(F=0.098,P=0.755) and had significant difference in different times in a same group(F=28.394, P=0.000).With time prolongation,the therapy and time had not interaction(F=2.192,P=0.072).It means the change tendency of AT-Ⅲactivity had not difference between different therapy groups.7.Patients' outcomeIn 20 patients of group A,seven cases had GOS range from 1 to 3 and 13 cases had GOS from 4 to 5.In the other 23 patients of group B,15 cases had GOS range 1 to 3 and 8 cases had GOS from 4 to 5.The difference between group A and B was significant(P=0.047).Conclusion:1.Sub-hypothermia therapy(with patients' body temperature in 32.0℃-35.0℃) could improve the hypercoagulable state of the patients with isolated severe head injury and reduce the subsequent hyperfibrinolysis.2.The outcome of the patients of sub-hypothermia group was better than that of control group and the difference was significant.It may be a study direction to correct this kind of coagulopathy after traumatic brain injury by sub-hypothermia therapy.