Effect of mild hypothermia on coagulation function and prognosis after acute moderate to severe craniocerebral injury
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摘要: 目的 研究急性中度至重度创伤性脑损伤患者凝血功能障碍特点及亚低温疗法对其预后影响。方法 这项回顾性队列研究纳入了2021年6月—2023年6月江苏大学附属武进医院重症医学科收治的中度至重度脑外伤的所有成年患者(152例)，获得了患者人口统计学和创伤特征的详细信息，根据患者28 d的预后分为存活组(107例)和死亡组(45例)；根据不同治疗方式分为亚低温治疗组(69例)和对照组(83例)。检测亚低温组和对照组入住重症医学科之后不同时间点凝血功能指标。结果 对比入选患者存活组与死亡组治疗前即刻凝血功能情况，死亡组凝血酶原时间、凝血酶时间、活化部分凝血活酶时间明显延长和D-二聚体明显增高，各组间差异均有统计学意义(P < 0.05)。存活组患者的亚低温组治疗结束后纤维蛋白原高于对照组，差异有统计学意义(P < 0.05)。结论 凝血功能障碍在急性中重型颅脑损伤后很常见，而亚低温治疗可能对凝血功能有一定影响，值得进一步研究。Abstract: Objective To study the characteristics of coagulation dysfunction in patients with acute moderate to severe traumatic brain injury(TBI)and the effect of mild hypothermia therapy on their prognosis.Methods This retrospective cohort study included all adult patients with moderate to severe TBI admitted to the Department of Critical Care Medicine of Wujin Hospital Affiliated to Jiangsu University from June 2021 to June 2023(152 cases), and obtained detailed information on patient demographics and trauma characteristics were obtained. According to the 28d prognosis of patients, they were divided into survival group(107 cases) and death group(45 cases). According to different treatment methods, they were divided into mild hypothermia group(69 cases) and control group(83 cases). The coagulation function of the mild hypothermia group and the control group at different time points was measured after admission to the intensive care department.Results The results showed that before treatment prothrombin time, thrombin time, activated partial thromboplastin time were significantly prolonged and D-dimer was significantly increased in the death group, and the differences among all groups were statistically significant(P < 0.05).In the survival group, the blood clotting index fibrinogen in the mild hypothermia group was higher than that in the control group, and the difference was statistically significant(P < 0.05).Conclusion Coagulation dysfunction is very common after acute moderate to severe cranial injury, and mild hypothermia may have a certain effect on coagulation function, which is worth further studying.
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表 1 患者基本临床资料
X±S 项目 28 d预后 治疗方式 存活组(107例) 死亡组(45例) t/χ2 P 亚低温组(69例) 对照组(83例) t/χ2 P 年龄/岁 58.21±17.79 59.20±17.69 -0.312 0.755 55.64±17.52 60.89±17.61 -1.836 0.068 高血压/例 55 25 0.595 0.734 33 47 2.193 0.334 冠心病/例 6 5 1.390 0.238 3 8 0.837 0.360 肾功能不全/例 1 2 0.611 0.434 0 3 - Fisher=0.251 脑血管病/例 9 3 0.133 0.716 5 7 0.073 0.787 糖尿病/例 13 5 0.033 0.856 6 12 1.198 0.274 APACH Ⅱ/分 17.72±6.72 19.58±7.82 -1.482 0.140 18.22±7.934 18.31±6.332 -0.083 0.934 GCS评分/分 7.79±2.92 7.69±3.02 0.184 0.855 7.59±3.084 7.89±2.824 -0.620 0.536 
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表 2 各组患者在急性中重度颅脑损伤后治疗前即刻凝血功能变化
X±S 项目 28 d预后 治疗方式 存活组(107例) 死亡组(45例) t/χ2 P 亚低温组(69例) 对照组(83例) t/χ2 P PT/s 12.06±1.68 17.78±17.63 -3.336 0.001 13.35±8.68 14.10±10.97 -0.455 0.647 TT/s 18.47±6.68 23.95±14.37 -3.215 0.002 20.45±9.55 19.79±10.21 0.407 0.684 INR 2.05±5.05 1.70±2.31 0.443 0.659 1.52±3.39 2.31±5.14 -1.087 0.279 APTT/s 25.22±7.71 32.91±17.01 -3.841 0.001 27.92±9.34 27.14±13.50 0.407 0.685 Fib/(g/L) 2.60±1.3 2.15±1.40 1.858 0.065 2.59±1.70 2.36±1.01 1.021 0.309 D-D/(mg/L) 19.18±26.36 37.99±67.01 -2.483 0.014 19.07±28.33 29.37±52.02 -1.471 0.144
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表 3 各组患者治疗结束后24 h凝血功能
X±S 项目 存活组 死亡组 亚低温组(50例) 对照组(57例) t/χ2 P 亚低温组(19例) 对照组(26例) t/χ2 P PT /s 12.16±2.01 11.81±1.82 0.974 0.332 12.67±3.58 16.75±17.53 -1.279 0.208 TT/s 15.35±2.81 15.16±2.07 0.416 0.678 17.42±9.64 24.90±22.31 -1.369 0.178 INR 1.23±1.12 1.16±0.93 0.388 0.699 1.12±0.22 2.03±2.98 -1.316 0.195 APTT/s 28.37±4.49 27.90±4.27 0.559 0.577 31.58±6.34 37.83±30.27 -0.883 0.383 Fib/(g/L) 5.86±2.82 4.88±1.90 2.131 0.035 4.88±3.03 3.92±1.78 2.724 0.009 D-D/(mg/L) 9.55±31.85 4.65±6.48 1.135 0.259 6.85±7.76 21.45±30.67 -2.020 0.050
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