Predictive Value of Continuous Monitoring of Blood Coagulation Indexes in Patients with Severe Craniocerebral Injury During Perioperative Period for Short-Term Prognosis
Objective To explore the changes in coagulation indicators during perioperative period in patients with severe craniocerebral injury and their predictive value for prognosis.Methods This study was a prospective study,taking 120 patients with severe brain injury who were treated in Xuchang Central Hospital from March 2020 to August 2022 as the research objects.After completing the treatment of hematoma removal+bone flap decompression,all the study subjects received a 6-month follow-up.The clinical prognosis of the patients was defined by Glasgow outcome scale(GOS),which was divided into good prognosis group and poor prognosis group.The blood coagulation indexes of the patients were dynamically examined at admission.The detection time points were admission(T1),postoperative 1 d(T2),postoperative 3 d(T3),postoperative 7 d(T4).The test items include thrombin time(TT),prothrombin time(PT),activated partial prothrombin time(APTT),fibrinogen(FIB)and D-Dimer(D-D).Repeated measurement was used to test the changes of coagulation indicators at different time points,and to test the predictive efficacy of coagulation indicators on clinical prognosis of patients with severe brain injury.Results Among the 120 patients enrolled in the study,3 cases were lost to follow-up,1 case withdrew from the study,and the remaining 116 cases were actual subjects.The poor prognosis rate of 116 patients was 54.31％.TT,PT and APTT of the two groups were shortened from time T2,FIB and D-D were increased from time T2,and the difference was statistically significant at different time points(P＜0.05).FIB and D-D levels in poor prognosis group were lower than those in good prognosis group at T1,and FIB and D-D levels in other time points were higher than those in good prognosis group on average,and the difference was statistically significant(P＜0.05).ROC curve was drawn,and the AUC of plasma FIB and D-D in patients with severe craniocerebral injury on the next day after operation to predict poor prognosis was 0.796 and 0.873,respectively.Conclusion The coagulation function of patients with severe craniocerebral injury changes dynamically at different times.The expression of plasma FIB and D-D continues to increase after severe craniocerebral injury,and the coagulation time is also shortened.The detection of plasma FIB and D-D on the next day after operation can predict the risk of poor prognosis in patients with severe craniocerebral injury.
severe craniocerebral injuryfibrinogenD-Dimercoagulation function
万方数据
维普
