Correlation Between Craniocerebral Trauma And Function Of Blood Coagulation

Objective:To investigate the characteristics and medical significance of blood coagulation and fibrinolysis in acute craniocerebral trauma,such that the relationship between the severity of injury and prognosis of patient.To explore the regular pattern of post-traumatic change in coagulation system,and in turn avoid impairment of micro-circulation,such as micro-thrombosis,hemorrhage of micro-vessel in lesion site and the surrounding tissue,or even DIC.This may in turn provide the new train of thought in minimizing consecutive injury of brain tissue and enhancing efficacy of treatment.The research may,at the same time,pave the way for future improvement in the skills of diagnosis,prognostic assessment and treatment eventually.Methods:1.The trial group comprised 30 patients who were diagnosed with craniocerebral trauma in our hospital.Levels of prothrombin time(PT),activated partial thromboplastin time(APTT),platelet count(PC),fibrinogen and fibrin degradation products(FDP) and D-dimer(DD) were determined at two different time points(at admission,the second and the fifth day after admission).Their levels were compared with those of the control group,which comprised 20 healthy volunteers.2.Patients were divided into three groups according to their Oxford Handicap Scale(OHS) after one-month in-house treatment.The levels of coagulation indication between three different groups were compared.All data were collected and analyzed with SPSS v.13.0 software.Results:1.Levels of PT,APTT,FDP and DD in trauma group were all higher on admission and the discrepancies were statistically significant(P＜0.01) compared with the control group.However, the discrepancies of level of PC were insignificant compared with the control group.Levels of PT and APTT descended with the lapse of time,such that they were higher than those of the control group on admission,and the values lay within the normal range where they were still at higher level on the second and the fifth day after admission.The DD levels of the trauma group on the second and fifth day were still higher than that of the control group(P＜0.01 and P＜0.05 respectively).Level of FDP showed an uphill trend in the course of the research(P＜0.01 and P＜0.05 respectively).2.Levels of PT,APTT,FDP and DD in severe and median trauma group were higher than those of mild trauma group on admission and the second day after admission,the discrepancies were statistically significant(P＜0.01 and P＜0.05 respectively).Levels of PT,APTT and FDP in severe trauma group were higher than those of median and mild trauma group on the fifth day after admission(P＜0.01).Levels of DD in severe trauma group were still higher than those of median and mild trauma group on the fifth day after admission,the discrepancies were statistically significant(P＜0.05).3.Levels of PT,APTT,FDP and DD in poor outcome and deceased group were higher than those of good outcome group,the discrepancies were statistically significant(P＜0.01).Under SNK-q test,the FDP,PC and DD levels of deceased and poor outcome group were compared at a=0.05 level and the insignificant discrepancies were resulted(P＞0.05).Conclusions:1.Patients with Craniocerebral trauma may develop coagulation changes at the early stage,which shows activation of both coagulating and fibrinolytic system,and followed by the prominent secondary fibrinolysis.Changes in multiple coagulation parameter,PT,APTT,FDP and DD are closely related to time span and progress in course of the trauma.2.Changes in multiple coagulation parameter,PT,APTT,FDP and DD are also related to severity of the trauma.3.Determination of coagulation parameter has remarkable clinical significance in prognostic assessment on patients with craniocerebral trauma.4.Although there is no consensus on management of coagulation change following craniocerebral trauma in the field of medicine,determination of coagulation parameter at early stage is still important to patients with craniocerebral trauma since it helps improve diagnosis and treatment, prevent secondary brain injury and delayed traumatic intracranial hematoma(DTIH),heighten cure rate and reduce death rate.