The Correlation Between Acute Traumatic Brain Injury Coagulopathy And Progressive Hemorrhagic Injury:Risk Factors Analysis

Part I:The Correlation between acute traumatic brain injury coagulopathy and progressive hemorrhagic injuryObjective:To investigate the clinical significance of coagulopathy with traumatic brain injury (TBI) patients, study the relation between Glasgow Coma Score (GCS) and Glasgow Outcome Scale (GOS) with coagultion parameters (PT, APTT, FG, TT, INR and PLT) leading to progressive hemorrhagic injury (PHI).Methods:(1) A total of154patients with acute traumatic brain injury were divided into mild, moderate and sever three groups, within24hours at admission, serum levels of prothrombintime (PT), activated partial thromboplastin time (APTT), fibrinogen (FG), thrombin time (TT), international normalized ratio (INR) and platelet (PLT) were documented, and compared with48healthy control group,(2) At the same time by compared TBI patients with consecutive CT scan to detemiine whether or not presence progressive hemorrhagic injury (PHI).(3) after6months of treatment, follow-up was divided into two groups:(1) GOS4-5scores (good prognosis) and1-3scores (poor prognosis), compared the deference between this groups with coagulpathy parameters to evaluate the prognosis of TBI patients. statistical analysis use SPSS13.0software processing,between two groups use One-way Anova analysis, q test, P<0.05was considered statistically significant. Results:serum levels of PT, APTT and INR were significantly higher than control group, while FG was significantly lower than control group (P<005) after mild, moderate and sever traumatic brain injury(TBI). and There was significant difference between groups. APTT, PT and INR levels were higher related to severity of injury, FG more lower (P<005). In Progressive hemorrhagic injury group PT, INR levels were significantly higher than non Progressive hemorrhagic injury (P<005), FG was significantly decreased (P<005). INR, FG and PLT were significant differences between poor and good prognosis groups (P <0.05).Conclusion:coagulopathy abnormalities presents after acute traumatic brain injury patients, and its levels closely related to degree of severity of injury. The early changes of serum levels of INR, PT and FG can be as predictors of progressive hemorrhagic injury (PHI).Part Ⅱ:Analysis Risk factors of progressive hemorrhagic injury after traumatic brain injuryObjective to investigate the Risk factors of progressive hemorrhagic injury (PHI) after acute traumatic brain injury.Method:From February2011to August2012, this prospective study was selected in Tong Ji Hospital neurosurgical department accordance with the inclusion criteria and exclusion criteria, a total of154patients were enrolled, according to the progressive of hemorrhage the patients divided into:progressive hemorrhagic injury group (n=62) and non-progressive hemorrhagic injury group (n=92). And compared between the two groups of patients with different variables as gender, age, Glasgow Coma Scale (GCS), hours of CT scan after injury (HCT1), type of injury and location, initial CT scan hematoma volume, to explore the occurrence of PHI. Use Logistic regression analysis to evaluate the risk factors of PHI occurrence。Results:the incidence of progressive hemorrhagic injury was62patients (40.2%). a total of154patients44of the105men occurred PHI,18of the49women occurred PHI, the difference was not significant; minimum age was18and oldest was72years old, there was statically significance in the relevance between PHI and age(P<0.05);123patients admitted to hospital within2hours after injury, Patients Performed their first CT scan earlier had a high detection of PHI Possibility(P<0.05); patients with low GCS group at admission PHI was higher than high GCS group, there was significant differences between groups (P<005); univariate analysis showed intracerebral hematoma and subdural hematoma will increase the incidence of PHI (P<0.05). Multivariate logistic regression analysis showed age, initial CT scan,brain contusion, skull fracture, subarachnoid hemorrhage, and epidural hematoma were the best predictor factors of PHI (P<0.01).Conclusion:The occurrence of progressive hemorrhagic injury is a result of many factors including Older, short time of injuries to the first CT scan, early CT scan that showed skull fracture, brain contusion, subarachnoid hemorrhage, epidural hematoma,with present of these factors Should be promptly repeated CT scan, to understand the condition of patients, timely treatment and improve the success of outcome.