The effects of mild-hypothermia therapy on coagulation and prognosis in patients with severe traumatic brain injury
10.3969/j.issn.1008-9691.2014.01.005
- VernacularTitle:亚低温对重型颅脑损伤患者凝血功能及预后的影响
- Author:
Jin LIANG
;
Jie ZHU
;
Jianguo LI
;
Sai ZHANG
;
Xuyi CHEN
- Publication Type:Journal Article
- Keywords:
Mild-hypothermia;
Severe traumatic brain injury;
Coagulation function;
Prognosis
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2014;(1):18-21
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effects of mild-hypothermia therapy on coagulation and prognosis in patients with severe traumatic brain injury(sTBI). Methods Forty sTBI patients with Glasgow coma score(GCS) 3-8 were randomly divided into normal temperature-treatment control group(NT group)and hypothermia-treatment group(HT group),each 20 cases. Both groups were given conventional therapy,and HT group was additionally given mild-hypothermia therapy. The values of prothrombin time(PT),activated partial thromboplastin time(APTT), thrombin time(TT) and concentrations of plasma fibrinogen(Fg),D-dimer(DD)in two groups were monitored dynamically. The incidences of frequently seen blood coagulation related complications,such as delayed hematoma, hyper-fibrinolysis,cerebral infarction were counted,and 3 months after injury,the standard glasgow outcome scale (GOS)was applied to assess the prognosis. Results The values of PT,APTT and TT were significantly shorter and reached their valley values after 12 hours in NT group〔PT(s):10.6±0.8 vs. 11.6±1.2,APTT(s):16.7±1.2 vs. 20.8±1.4,TT(s):9.8±0.8 vs. 13.6±0.8〕,the concentrations of plasma Fg,DD were obviously increased and reached their peak values after 12 hours〔Fg(g/L):3.2±0.9 vs. 2.5±0.8,DD(μg/L):4 126.7±1 170.3 vs. 873.5±140.2〕,which showed that hypercoagulability appeared in the first 12 hours after injury in NT group,and after 12 hours turned into hyper-fibrinolysis. However,the values of PT,APTT,TT extended slowly until 12 hours reaching to their peak values〔PT(s):14.4±0.9 vs. 10.9±1.0,APTT(s):45.4±1.0 vs. 20.2±1.0,TT(s):25.3±1.2 vs. 13.0±0.6〕,the concentration of plasma Fg declined gradually until 12 hours to its valley value(g/L:1.8±0.7 vs. 2.3±0.6)and then back to normal,the concentration of DD rose gradually until 12 hours reaching to its peak value(μg/L:3 079.8±947.6 vs. 795.6±120.7)and then back to normal at 72 hours in HT group. The time of recovery for above indexes in HT group was earlyer than that in NT group. The incidence of delayed hematoma in NT group was higher than that of HT group(10%vs. 5%),but there was no statistical significant difference between the two groups(P>0.05),and the incidences of hyper-fibrinolysis(5% vs. 35%,P<0.05)and cerebral infarction (0 vs. 25%,P<0.05)in HT group were obviously lower than those in NT group. The rate of good therapeutic effect was higher(30% vs. 5%,P<0.05),and mortality lower(10% vs. 25%,P<0.05)in HT group than that of NT group. Conclusion Mild-hypothermia therapy can ameliorate coagulation dysfunction, reduce morbidity of coagulation related complications,and can improve the prognoses of patients with sTBI.
