创伤性脑损伤患者早期凝血功能紊乱的发生危险因素分析及临床意义

Analysis of Risk Factors for Early Coagulopathy in Patients with Traumatic Brain Injury and Its Clinical Significance

摘要: 目的：探讨创伤性脑损伤(Traumatic Brain Injury, TBI)患者早期凝血功能紊乱的发生危险因素，为临床早期识别、干预及改善预后提供参考依据。方法：回顾性收集2022年1月至2024年1月于新疆医科大学第六附属医院急诊创伤中心住院治疗的156例TBI患者的临床资料，根据患者伤后24 h内凝血功能检查结果分为凝血功能紊乱组(病例组)和凝血功能正常组(对照组)。收集患者的基线资料、损伤相关指标、临床干预措施等潜在危险因素，采用单因素分析筛选差异有统计学意义的变量，再通过多因素Logistic回归分析确定TBI患者早期凝血功能紊乱的独立危险因素。结果：156例TBI患者中，早期凝血功能紊乱的发生率为48.08% (75/156)。单因素分析显示，年龄 ≥ 60岁、格拉斯哥昏迷量表(GCS)评分 ≤ 8分、硬膜下血肿、脑内血肿、蛛网膜下腔出血、损伤严重程度评分(ISS) ≥ 25分、低血压、低氧血症、大量输血(≥4U)、手术治疗、合并其他部位损伤等因素与TBI患者早期凝血功能紊的发生相关(P < 0.05)。多因素Logistic回归分析显示，GCS评分 ≤ 8分(OR = 3.852, 95% CI: 1.863~7.965, P < 0.001)、ISS评分 ≥ 25分(OR = 3.215, 95% CI: 1.587~6.513, P = 0.001)、低血压(OR = 2.987, 95% CI: 1.423~6.265, P = 0.004)、大量输血(≥4U) (OR = 2.764, 95% CI: 1.312~5.827, P = 0.008)及合并蛛网膜下腔出血(OR = 2.543, 95% CI: 1.231~5.256, P = 0.012)是TBI患者早期凝血功能紊乱的独立危险因素。结论：TBI患者早期凝血功能紊乱发生率较高，GCS评分 ≤ 8分、ISS评分 ≥ 25分、低血压、大量输血及合并蛛网膜下腔出血是其独立危险因素，临床需针对这些高危因素加强监测与干预，以降低凝血功能紊乱的发生风险。

Abstract: Objective: To investigate the risk factors for early coagulopathy in patients with Traumatic Brain Injury (TBI) and to provide a reference for early clinical identification, intervention, and prognosis improvement. Methods: Clinical data of 156 TBI patients hospitalized in the Emergency Trauma Center of the Sixth Affiliated Hospital of Xinjiang Medical University from January 2022 to January 2024 were retrospectively collected. Based on coagulation test results within 24 hours post-injury, patients were divided into a coagulopathy group (case group) and a normal coagulation function group (control group). Baseline data, injury-related indicators, clinical interventions, and other potential risk factors were collected. Univariate analysis was used to screen variables with statistically significant differences, followed by multivariate logistic regression analysis to identify independent risk factors for early coagulopathy in TBI patients. Results: Among the 156 TBI patients, the incidence of early coagulopathy was 48.08% (75/156). Univariate analysis showed that age ≥60 years, Glasgow Coma Scale (GCS) score ≤ 8, subdural hematoma, intracerebral hematoma, subarachnoid hemorrhage, Injury Severity Score (ISS) ≥25, hypotension, hypoxemia, massive transfusion (≥4 units), surgical treatment, and combined injuries in other body regions were associated with the occurrence of early coagulopathy in TBI patients (P < 0.05). Multivariate logistic regression analysis identified GCS score ≤8 (OR = 3.852, 95% CI: 1.863~7.965, P < 0.001), ISS score ≥25 (OR = 3.215, 95% CI: 1.587~6.513, P = 0.001), hypotension (OR = 2.987, 95% CI: 1.423~6.265, P = 0.004), massive transfusion (≥4 units) (OR = 2.764, 95% CI: 1.312~5.827, P = 0.008), and combined subarachnoid hemorrhage (OR = 2.543, 95% CI: 1.231~5.256, P = 0.012) as independent risk factors for early coagulopathy in TBI patients. Conclusion: The incidence of early coagulopathy is high in TBI patients. Independent risk factors include GCS score ≤8, ISS score ≥25, hypotension, massive transfusion, and combined subarachnoid hemorrhage. Clinical practice should enhance monitoring and intervention targeting these high-risk factors to reduce the risk of coagulopathy.