医学临床研究
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医学临床研究  2021, Vol. 38 Issue (4): 501-503    DOI: 10.3969/j.issn.1671-7171.2021.04.006
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不同时间窗使用氨甲环酸对颅脑创伤预后的影响*
倪燕青1, 顾昀来1**, 冯军峰2
1.上海市浦东新区医疗急救中心,上海 201206;
2.上海交通大学医学院附属仁济医院神经外科,上海 201206
Effect of Tranexamic Acid in Different Time Windows on the Prognosis of Traumatic Brain Injury
NI Yan-qing, GU Yun-lai, FENG Jun-feng
Shanghai Pudong New Area Medical Emergency Center, Shanghai 201206, China
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摘要 【目的】 比较院前和院内使用氨甲环酸对颅脑创伤患者预后的影响。【方法】 采用前瞻性随机对照研究分析126例颅脑创伤[格拉斯哥昏迷评分(GCS)≤12分]患者临床特征,患者男72例,女54例。以治疗时间窗为标准,分为A组(时间窗<30 min,46例)、B组(时间窗1 h,42例)和C组(时间窗3 h,38例)。A组于急救现场(<30 min)静脉注射氨甲环酸1 g;B组于入院后(1 h)静脉注射氨甲环酸1 g,C组完善检查后(3 h)静脉注射氨甲环酸1 g。患者手术、其他用药情况均按常规操作。记录救护车平均到达时间、出车到用药时间,观察入院当时、伤后1 d患者血浆中纤维蛋白降解产物(FDP)、D-二聚体等指标,比较患者神经外科ICU(NICU)入住时间、弥漫性血管内凝血(DIC)评分、伤后3个月的格拉斯哥预后评分(GOS)。【结果】 三组救护车到达时间比较差异无显著性(P>0.05),A组氨甲环酸用药时间早于B组和C组,B组则早于C组,且各组之间相比较差异均有显著性(P<0.01)。三组急诊入院时的FDP、D-二聚体等指标水平相比较差异无显著性(P>0.05)。而入院1 d后,A组FDP、D-二聚体显著低于B和C组(P<0.05),DIC评分和NICU入住时间A组显著低于其他两组(P<0.05),A组伤后3个月GOS评分高于B组和C组,且差异均有显著性(P<0.05)。【结论】 颅脑创伤使用氨甲环酸治疗窗前移可以有效改善外伤性凝血功能障碍,减少进展性颅内出血,患者预后更好。
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倪燕青
顾昀来
冯军峰
关键词 颅脑损伤/治疗氨甲环酸/治疗应用时间因素预后    
Abstract【Objective】 To compare the effects of tranexamic acid on the prognosis of patients with traumatic craniocerebral trauma . 【Methods】 A prospective randomized controlled trial was conducted to analyze the clinical data of 126 patients with traumatic brain injury (GCS ≤ 12), which includes 72 males and 54 females . The patients were divided into Group A (time window < 30 minutes, 46 cases), Group B (time window =1 hour, 42 cases), and Group C (time window =3 hours, 38 cases). Patients of Group A received an intravenous injection of tranexamic acid with a dosage of 1 g at the scene of emergency aid (time window < 30 minutes); patients of Group B took an intravenous injection of tranexamic acid with a dosage of 1 g after admission (time window=1 hour), and patients of Group C took an intravenous injection of 1 g tranexamic acid after a complete examination (time window=3 hours). The operations and other medications were performed according to the routine operations. The average time of ambulance arrivals and the average time of transportation are recorded, and the plasma levels of FDP and D-dimer were observed at the time of admission and 1 day after injury, and a comparison of the times of ICU, DIC score and Glasgow Outcome Score (GOS) at 3 months after injury was also performed. 【Results】 There was no significant difference in the arrival times of ambulance among the three groups. The levels of FDP and D-dimer in the three groups were totally similar (P>0.05). However, 1 day after hospital admission, FDP and D-dimer in the Group A are significantly lower than those in the group B and C; DIC score and NICU time in the Group A were significantly lower than those in the other two groups. The GOS score and prognosis of the Group A were higher in 3 months after injury, and the differences were statistically significant (P<0.05). 【Conclusion】 Tranexamic acid can effectively improve the traumatic coagulation dysfunction, it is available to reduce progressive intracranial hemorrhage with a better prognosis.
Key wordsCraniocerebral Trauma/TH    Tranexamic Acid/TU    Time Factors    Prognosis
收稿日期: 2021-01-12     
中图分类号:  R651.15  
基金资助:* 浦东新区卫生和计划生育委员会卫生科技项目(项目编号:PW2015A-7)
通讯作者: ** E-mail:565352838@qq.com   
引用本文:   
倪燕青, 顾昀来, 冯军峰. 不同时间窗使用氨甲环酸对颅脑创伤预后的影响*[J]. 医学临床研究, 2021, 38(4): 501-503.
NI Yan-qing, GU Yun-lai, FENG Jun-feng. Effect of Tranexamic Acid in Different Time Windows on the Prognosis of Traumatic Brain Injury. JOURNAL OF CLINICAL RESEARCH, 2021, 38(4): 501-503.
链接本文:  
http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2021.04.006     或     http://journal07.magtech.org.cn/yxlcyj/CN/Y2021/V38/I4/501
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