Abstract:

Objective　To explore the effect of cryoprecipitate combined with tranexamic acid for patients with coagulopathy caused by cranial trauma. Methods　From January 2022 to December 2023, 118 patients with coagulopathy caused by cranial trauma treated at Chang'an Hospital were selected for the randomized controlled trial, and were divided into a control group and an experimental group by the random number table method, with 59 cases in each group. There were 29 males and 30 females in the control group; they were (42.35±12.58) years old. There were 31 males and 28 females in the experimental group; they were (43.27±11.94) years old. The control group were treated with cryoprecipitate, and the experimental group with cryoprecipitate and tranexamic acid. The coagulation function [thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), and platelet count (PLT)], serum levels of growth factors [transforming growth factor β1 (TGF-β1), vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bF-GF)], levels of inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8)], levels of fibrinolysis indicators [fibrin degradation products (FDP), and D-dimer (D-D)], and incidence rates of complications were compared between the two groups. t and χ² tests were used for the statistical analysis. Results　Before the treatment, there were no statistical differences in the coagulation function and levels of growth factors, inflammatory factors, and fibrinolysis indicators between the two groups (all P>0.05). After 3 days' treatment, the TT, PT, and APTT in the experimental group were shorter than those in the control group [(14.87±2.46) s vs. (17.01±2.81) s, (14.35±2.68) s vs. (16.99±2.93) s, and (37.01±5.41) s vs. (42.85±5.47) s]; the levels of Fg, PLT, TGF-β1, VEGF, bF-GF, and IL-8 in the experimental group were higher than those in the control group [(1.68±0.29) g/L vs. (1.42±0.24) g/L, (89.77±6.46)×10⁹/L vs. (79.00±6.81)×10⁹/L, (16.65±3.92) ng/L vs. (13.16±3.53) ng/L, (39.77±5.84) μg/L vs. (35.31±5.58) μg/L, (27.74±3.62) μg/L vs. (23.32±3.15) μg/L, and (21.78±4.64) μg/L vs. (18.47±3.90) μg/L]; the levels of TNF-α, IL-6, FDP, and D-D in the experimental group were lower than those in the control group [(2.03±0.27) μg/L vs. (2.84±0.21) μg/L, (2.85±0.73) μg/L, vs. (3.91±0.66) μg/L, (2.75±0.32) mg/dL vs. (5.47±0.82) mg/dL, and (0.97±0.28) mg/L vs. (1.65±0.34) mg/L]; there were statistical differences (t=4.401, 5.107, 5.831, 5.305, 8.813, 5.082, 4.241, 7.075, 4.195, 18.189, 8.273, 23.736, and 11.859; all P<0.05). There was no statistical difference in the incidence rate of adverse reactions between the experimental group and the control group [3.39% (2/59) vs. 10.17% (7/59); χ²=2.145; P=0.143]. Conclusion　Cryoprecipitate combined with tranexamic acid for patients with coagulopathy caused by cranial trauma is effective, and can improve their coagulation markers and levels of growth factors, reduces inflammatory responses, and decrease the occurrence of adverse reactions.

Key words:

Coagulopathy, Cryoprecipitate, Cranial trauma, Treatment effect

摘要：

目的　探讨冷沉淀凝血因子联合氨甲环酸在颅脑创伤性凝血功能障碍患者中的应用效果。方法　采用前瞻性研究，选取2022年1月至2023年12月在长安医院治疗的118例颅脑创伤性凝血功能障碍患者作为研究对象，通过随机数字表法分为对照组（59例）和试验组（59例）。对照组男29例、女30例，年龄（42.35±12.58）岁，接受冷沉淀凝血因子治疗；试验组男31例、女28例，年龄（43.27±11.94）岁，接受冷沉淀凝血因子联合氨甲环酸治疗。对比两组凝血功能［凝血酶时间（TT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fg）、血小板计数（PLT）］、血清生长因子水平［转化生长因子β1（TGF-β1）、血管内皮生长因子（VEGF）、碱性成纤维细胞因子（bF-GF）］、炎症因子［血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）］、纤溶指标［血浆中纤维蛋白降解产物（FDP）、D-二聚体（D-D）水平］及并发症发生情况。统计学方法采用t检验、χ²检验。结果　治疗前，两组患者凝血功能、血清生长因子、炎症因子、纤溶指标比较，差异均无统计学意义（均P>0.05）。治疗3 d后，试验组TT、PT、APTT均短于对照组［（14.87±2.46）s比（17.01±2.81）s、（14.35±2.68）s比（16.99±2.93）s、（37.01±5.41）s比（42.85±5.47）s］，Fg、PLT、TGF-β1、VEGF、bF-GF、IL-8水平均高于对照组［（1.68±0.29）g/L比（1.42±0.24）g/L、（89.77±6.46）×10⁹/L比（79.00±6.81）×10⁹/L、（16.65±3.92）ng/L比（13.16±3.53）ng/L、（39.77±5.84）μg/L比（35.31±5.58）μg/L、（27.74±3.62）μg/L比（23.32±3.15）μg/L、（21.78±4.64）μg/L比（18.47±3.90）μg/L］，TNF-α、IL-6、FDP、D-D水平均低于对照组［（2.03±0.27）μg/L比（2.84±0.21）μg/L、（2.85±0.73）μg/L比（3.91±0.66）μg/L、（2.75±0.32）mg/dL比（5.47±0.82）mg/dL、（0.97±0.28）mg/L比（1.65±0.34）mg/L］，差异均有统计学意义（t=4.401、5.107、5.831、5.305、8.813、5.082、4.241、7.075、4.195、18.189、8.273、23.736、11.859，均P<0.05）。试验组不良反应发生率为3.39%（2/59），与对照组10.17%（7/59）比较，差异无统计学意义（χ²=2.145，P=0.143）。结论　冷沉淀凝血因子联合氨甲环酸治疗颅脑创伤性凝血功能障碍效果显著，可改善患者凝血指标，提高生长因子水平，降低炎症反应，并减少不良反应发生情况。

关键词:

凝血功能障碍, 颅脑创伤, 氨甲环酸, 疗效