Clinical Analysis Of Secondary MODS With Coagulation And Glucose In Acute Traumatic Brain Injury

Traumatic brain injury fatality rate ranks first in traffic accident(85%)and has become one of the major threat to human life. Traumatic brain injury especially the severe craniocerebral injury has attracted great attention due to its high disability and mortality. Excessive stress of blood sugar and blood coagulation changes can occur in patients with trauma, infection and major surgery. Patients with hypercoagulable state and blood glucose stress in acute craniocerebral injury can increase the expression of lipopolysaccharide (LPS), tumor necrosis factor-a (TNF) and other inflammatory factors, which can make the systemic inflammatory response syndrome show amplified cascade and then increase the risk of infection caused by trauma. Infection excessive stress, blood sugar excessive stress and hypercoagulable state relate and reinforce to each other, the vicious cycle of "inflammatory response - high blood sugar, hypercoagulable state - inflammatory response" increases the incidence of MODS and mortality. Traumatic brain injury early stress hyperglycemia has been shown to independently affect the prognosis of patients after trauma, but there is no consensus target reasonable blood glucose control。Intensive insulin therapy can effectively reduce the complications (particularly infections) and mortality, to maintain blood glucose normalization of ICU stay of critically ill patients can improve prognosis; Application of mild hypothermia therapy, active infusion of fresh plasma, coagulation factors and platelet complement , which can effectively control blood clotting disorders, blood coagulation and fibrinolysis changes and blood glucose control in traumatic brain injury play a very important position. In many years of clinical research and practice, we found that blood glucose and post-traumatic coagulopathy have certain correlation with secondary MODS。The study of patients with acute traumatic brain function and blood coagulation and fibrinolysis changes in the level of Law, and to explore its relationship with secondary MODS, acute traumatic brain injury so as to strictly control blood sugar and adjust the treatment of coagulation provides a theoretical basis, may reduce the mortality rate of traumatic brain injury.Objective:Early studies of varying degrees in traumatic brain injury and the acute phase of coagulation-fibrinolysis function and blood glucose levels, and explore the function of coagulation-fibrinolysis and blood glucose levels in patients with secondary MODS relationship.Methods:Subjects selected from January 2009 to May 2010 into ICU and neurosurgical ICU patients with traumatic brain injury, a total of 89 cases. Inclusion criteria: admission within 24 hours of onset of brain CT examination confirmed the parallel traumatic brain injury, and the past without diabetes and patients with coagulopathy. According to Glasgow coma scale to 89 patients divided into 3 groups: mild injury group (13-15 points), moderate injury group (9-12 points), severe injury group (≤8 points), divided according to whether the merger MODS MODS for the combined group (A group) and non-MODS group combined (B group). Control group subjects from health examination center, a total of 20 cases. General admission records of patients in each group, normal blood clotting, blood sugar checks, and other indicators of organ function test results. The diagnostic criteria for MODS modified diagnostic criteria Fry-MODS。Result:①Mild, moderate and severe head trauma with the incidence of MODS was 16.7%, 32%, 65.2%;②With the severity of brain injury, coagulation parameters PT, APTT, FDP, DD showed a rising trend However, compared with the control group, mild and moderate injury group, PT was no statistically significant difference (P> 0.05), there were significant differences in PT severe injury group (P <0.05); Different degrees of injury group, APTT, FDP, DD and the normal control group, the difference was statistically significant (P <0.05); Different degrees of blood glucose in patients with traumatic brain injury group compared with the control group the difference was statistically significant (P <0.05).③MODS group of patients with traumatic brain injury combined with the non-MODS group, blood glucose, PT, APTT, FDP, DD levels the differences were statistically significant (P <0.05).Discussion: With traumatic brain injury patients at home and abroad coagulation of blood sugar or the gradual in-depth, many scholars believe that the brain post-traumatic stress and high blood sugar and coagulation disorders on the prognosis of patients with traumatic brain injury have an important impact. But for the early traumatic brain injury, blood sugar and coagulation changes in the relationship between secondary MODS rare clinical reports. In this study, early changes of blood sugar and coagulation and the relationship between the incidence of MODS in traumatic brain injury, the coagulation-fibrinolysis and blood glucose levels in patients with early changes regular function multiple organ dysfunction syndrome in for early brain injury and regulation of tight glycemic control to provide clinical evidence of coagulation disorders.Hulka and Scherer study neurosurgery and ICU patients with varying degrees of traumatic brain injury early PT, APTT, FDP, DD and blood sugar, found early brain injury and other aspects of coagulation and blood glucose compared with normal patients was significantly different, with the exception of the higher level, the mortality rate increased, So blood glucose and coagulation in traumatic brain injury of varying degrees influence significantly the prognosis of patients with plasma PT, APTT, FDP, DD, and blood glucose increased the degree of traumatic brain injury, GCS score decreased, MODS incidence gradually.Increased regulation of early control of blood glucose levels and blood coagulation disorders after traumatic brain injury may help reduce the incidence of secondary MODS ,to severe head trauma patients and improve the prognosis.Conclusion:1.The existence of patients with acute brain trauma stress disorder of blood sugar and coagulation is closely related with the change on the degree of severity in traumatic brain injury . 2.Blood glucose and coagulation changes of traumatic brain injury was related to the occurrence of secondary MODS, early control of blood glucose levels and blood coagulation disorders after traumatic brain injury may reduce the incidence of secondary MODS to improv traumatic brain injury prognosis.