Disseminated intravascular coagulation with increased fibrinolysis during the early phase of isolated traumatic brain injury.
Disseminated intravascular coagulation with increased fibrinolysis during the early phase of isolated traumatic brain injury.
复制标题
在孤立的创伤性脑损伤的早期阶段，血管内凝血与纤维蛋白溶解的增加。
DOI：
10.1186/s13054-017-1808-9
复制
发表时间：
2017-08-22
期刊：
影响因子：
--
通讯作者：
Sawamura A
中科院分区：
文献类型：
--
作者：
Wada T;Gando S;Maekaw K;Katabami K;Sageshima H;Hayakawa M;Sawamura A
有证据表明，发生在外伤性脑损伤患者的凝血功能障碍与弥散性血管内凝血（DIC）一致。我们假设在孤立性外伤性脑损伤（iTBI）早期伴有纤维蛋白溶解增加的DIC影响患者的预后，并且低灌注有助于DIC的高纤维蛋白溶解。本回顾性研究纳入92例iTBI患者，根据日本急性医学协会DIC评分系统分为DIC组和非DIC组。DIC患者被细分为有和没有高纤溶的患者。测定血小板计数、凝血和纤溶指标。系统性炎症反应综合征（SIRS）、器官功能障碍（序贯性器官衰竭评估评分）、组织灌注不足（乳酸水平评估）和输血量也进行了评估。结果测量为全因住院死亡率。与非DIC患者相比，DIC患者表现为消耗性凝血功能障碍，抗凝血酶水平较低，纤维蛋白/纤维蛋白原降解产物（FDP）和d -二聚体水平较高。所有DIC患者均发生SIRS并伴有器官功能障碍，需要更高的输血量，导致预后比非DIC患者差。这些变化在伴有高纤溶的DIC中更为明显。较高的FDP/ d -二聚体比率表明DIC属于纤维蛋白溶解表型，涉及纤维蛋白（原）溶解。有和没有DIC的患者到达时的平均血压相同。低灌注和乳酸水平未被确定为高纤溶的独立预测因子。DIC，尤其是伴有高纤溶的DIC，影响iTBI患者的预后。在这种类型的DIC中，低血压引起的组织灌注不足不会导致高纤溶。本文的在线版本（doi:10.1186/s13054-017-1808-9）包含补充材料，仅供授权用户使用。
There is evidence to demonstrate that the coagulopathy which occurs in patients with traumatic brain injury coincides with disseminated intravascular coagulation (DIC). We hypothesized that DIC with increased fibrinolysis during the early stage of isolated traumatic brain injury (iTBI) affects the outcome of the patients and that hypoperfusion contributes to hyperfibrinolysis in the DIC. This retrospective study included 92 patients with iTBI who were divided into DIC and non-DIC groups according to the Japanese Association Acute Medicine DIC scoring system. The DIC patients were subdivided into those with and without hyperfibrinolysis. The platelet counts and global markers of coagulation and fibrinolysis were measured. Systemic inflammatory response syndrome (SIRS), organ dysfunction (assessed by the Sequential Organ Failure Assessment score), tissue hypoperfusion (assessed by the lactate levels) and the transfusion volume were also evaluated. The outcome measure was all-cause hospital mortality. DIC patients showed consumption coagulopathy, lower antithrombin levels and higher fibrin/fibrinogen degradation products (FDP) and D-dimer levels than non-DIC patients. All of the DIC patients developed SIRS accompanied by organ dysfunction and required higher blood transfusion volumes, leading to a worse outcome than non-DIC patients. These changes were more prominent in DIC with hyperfibrinolysis. A higher FDP/D-dimer ratio suggests that DIC belongs to the fibrinolytic phenotype and involves fibrin(ogen)olysis. The mean blood pressures of the patients with and without DIC on arrival were identical. Hypoperfusion and the lactate levels were not identified as independent predictors of hyperfibrinolysis. DIC, especially DIC with hyperfibrinolysis, affects the outcome of patients with iTBI. Low blood pressure-induced tissue hypoperfusion does not contribute to hyperfibrinolysis in this type of DIC. The online version of this article (doi:10.1186/s13054-017-1808-9) contains supplementary material, which is available to authorized users.
登录
查看更多内容
幸存的败血症运动：严重败血症和化粪池冲击管理的国际指南，2012年。
影响因子：
38.9
作者：
Dellinger RP;Levy MM;Rhodes A;Annane D;Gerlach H;Opal SM;Sevransky JE;Sprung CL;Douglas IS;Jaeschke R;Osborn TM;Nunnally ME;Townsend SR;Reinhart K;Kleinpell RM;Angus DC;Deutschman CS;Machado FR;Rubenfeld GD;Webb S;Beale RJ;Vincent JL;Moreno R;Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
通讯作者：
Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
影响因子：
7.1
作者：
Asakura H
通讯作者：
Asakura H
影响因子：
4.2
作者：
Nakae, Ryuta;Takayama, Yasuhiro;Yokota, Hiroyuki
通讯作者：
Yokota, Hiroyuki
影响因子：
4.1
作者：
Stein, SC;Chen, XH;Smith, DH
通讯作者：
Smith, DH
影响因子：
2.8
作者：
Tian, Heng-Li;Chen, Hao;Chen, Shi-Wen
通讯作者：
Chen, Shi-Wen