关键字：川芎嗪 弥漫性轴索损伤 凝血功能
Diffuse Axonal Injury
WU Lianggui， WANG Gang ，LI Hongwei， MAI Rongkang， DONG Linjiang
(Affiliated Shenzhou Baoan Hospital, South Medical University, Shenzhen 518101, China)Abstract: Objective To explore the effect of tetramethylpyrazine on blood coagulation of patients with diffuse axonal injury(DAI).Methods 62 patients with DAI were randomly into 2 groups. Group I (n=30)received conventional therapy and group II(n=32) received conventional therapy plus Tetramethylpyrazine treatment. Indices of blood coagulation such as platelets count, prothrombin time, fibrinogen and Ddimer were measured before and after therapy and the indices were compared. Results The platelets count, prothrombin time, the level of fibrinogen and Ddimer were significantly increased and were decreased to normal level in 1 week after Tetramethylpyrazine infusion intravenously(P<0.05). The blood coagulation indices of group I were significantly higher than that in group II.Conclusion Tetramethylpyrazine can improve the function of blood coagulation and then improve the prognosis of patients with diffuse axonal injury.Key words: Diffuse axonal injury; Blood coagulation; Tetramethylpyrazine;
弥漫性轴索损伤(diffuse Axonal injury,DAI)临床较为常见，是在外力作用下脑内发生的以神经轴索断裂为特征的一系列病理生理变化的颅脑损伤疾病,诊断和治疗较为困难。因急性脑损伤促使组织凝血酶原激酶被激活释放血液中，启动凝血过程引起高凝状态，甚至发展为DIC，致预后不良。因此对DAI患者进行有关凝血功能的测定，对临床治疗有指导意义。
1 资料与方法
1.1 一般资料 本文共收集62例DAI患者，男50例，女12例，年龄17～58岁。① 62例在头部外伤后1～8 h入院。② 入院时GCS评分为6～8分，均排除其它系统严重复合伤。③ 外伤后均出现昏迷。④ 无明显神经系统定位体征。⑤ MRI扫描：脑实质内可见1.5～3.0 cm直径的出血灶，蛛网膜下腔或脑室系统出血，弥漫性脑水肿，中线轻度移位5例，其余无明显移位。⑥ 有7例行气管切开或气管内插管，无手术者。⑦ 既往无肝、肾、血液病史，肝、肾功能无异常。
1.2 凝血功能测定 62例DAI患者入院治疗前和治疗后5 d进行血小板计数、纤维蛋白原定量、D二聚体水平的检测，并对各项指标进行统计对比。
1.3 分组 62例依性别年龄和GCS评分等方面随机分2组，川芎嗪治疗组32例(川芎嗪组)，用常规方法治疗组30例(常规组)。另选10例头部轻度单纯性外伤者作对照组，
1.4 治疗方法 两组均给予降颅压、脱水、营养脑神经药物，抗感染、镇静等常规方法治疗，治疗观察期间无输血或用血液制品药物，川芎嗪组给予川芎嗪注射液200 ml(0.2 g)静注，每日1次，共7 d。
1.5 统计学方法
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