创伤前口服阿司匹林对创伤性颅脑损伤术后患者预后的影响
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摘要
目的探讨创伤前口服阿司匹林对创伤性颅脑损伤(TBI)患者临床预后的影响。方法采用格拉斯哥昏迷评分法(GCS)评定颅脑损伤患者入院时神经恶化情况,术后24h复查头颅CT对患者术后情况进行评定,出院时格拉斯哥预后量表(GOS)对患者进行功能评定,出院后6个月随访并采用生活自理能力评分(ADL),对患者生活自理能力进行评价。结果阿司匹林组与非用药组入院时GCS评分、术后再出血、出院时GOS评分、预后良好率和随访ADL评分及生活自理率无统计学差异(P>0.05),但阿司匹林组住院期间死亡率较非用药组高(P<0.05)。结论术前口服阿司匹林不能引起神经损害加重及增加残疾率,未影响患者出院总体预后,但可能会增加患者住院期间死亡率。
Objective To investigate the effect of preoperative aspirin treatment on the prognosis of patients with traumatic brain injury(TBI) after operation. Methods The Glasgow coma score was used to assess the neurological deterioration of the patients with craniocerebral injury at admission. 24 hours after the operation, the craniocerebral CT was evaluated after the operation, and the Glasgow prognosis scale(GOS) was used to assess the patients' outcome, the patients were followed up for 6 months after discharge, and the patients were evaluated with self-care ability score(ADL). Results There was no significant difference in GCS score, postoperative hemorrhage,prognosis of GOS score and ADL score between the aspirin group and non-aspirin group(P>0.05),but the mortality rate of aspirin group was higher than that of non-aspirin group(P<0.05). Conclusion Preoperative aspirin treatment does not cause aggravation of nerve damage,and does not increase the rate of disability. It does not affect the overall prognosis of discharged patients,but may increase the mortality during hospitalization.
Objective To investigate the effect of preoperative aspirin treatment on the prognosis of patients with traumatic brain injury(TBI) after operation. Methods The Glasgow coma score was used to assess the neurological deterioration of the patients with craniocerebral injury at admission. 24 hours after the operation, the craniocerebral CT was evaluated after the operation, and the Glasgow prognosis scale(GOS) was used to assess the patients' outcome, the patients were followed up for 6 months after discharge, and the patients were evaluated with self-care ability score(ADL). Results There was no significant difference in GCS score, postoperative hemorrhage,prognosis of GOS score and ADL score between the aspirin group and non-aspirin group(P>0.05),but the mortality rate of aspirin group was higher than that of non-aspirin group(P<0.05). Conclusion Preoperative aspirin treatment does not cause aggravation of nerve damage,and does not increase the rate of disability. It does not affect the overall prognosis of discharged patients,but may increase the mortality during hospitalization.
引文
1徐亮,张相双,王维东,等.重型颅脑损伤65例标准大骨瓣开颅治疗体会[J].临床神经外科杂志,2016,13(2):150-151
2张泽立,刘文明,张源,等.双侧去骨瓣减压术治疗幕上重型颅脑创伤的疗效[J].中华神经外科杂志,2017,33(7):673-676
3黄纯真.重型颅脑损伤治疗方法的研究进展[J].中华神经创伤外科电子杂志,2015,1(1):45-48
4弓开弦.影响急性颅脑损伤患者预后的相关因素分析[J].临床医学研究与实践,2017,2(14):12-13
5吴莎莎,李红娟,饶高峰.康复治疗对2型糖尿病并发脑卒中患者日常生活自理能力改善作用观察[J].中国基层医药,2017,24(19):2914-2917
6 Bonville DJ,Ata A,Jahraus CB,et al.Impact of preinjury warfarin and antiplatelet agents on outcomes of trauma patients[J].Surgery,2011,150(4):861-868
7 Grandhi R,Harrison G,Voronovich Z,et al.Preinjury warfarin,but not antiplatelet medications,increases mortality in elderly traumatic brain injury patients[J].J Trauma Acute Care Surg,2015,78(3):614-621
8 Tollefsen MH,Vik A,Skandsen T,et al.Patients with moderate and severe traumatic brain injury:impact of preinjury platelet inhibitor or warfarin treatment[J].World Neurosurgery,2018,114:e209-217
9 Peck KA,Calvo RY,Schechter MS,et al.The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury[J].J Trauma Acute Care Surg,2014,76(2):431-436
10刘强,宋平.GOS和ADL评价不同术式及时间窗治疗高血压脑出血的疗效[J].中西医结合心脑血管病杂志,2017,15(4):489-491
11冯玉建.原发性脑干损伤60例救治体会[J].中国实用医药,2014,9(26):127-128
2张泽立,刘文明,张源,等.双侧去骨瓣减压术治疗幕上重型颅脑创伤的疗效[J].中华神经外科杂志,2017,33(7):673-676
3黄纯真.重型颅脑损伤治疗方法的研究进展[J].中华神经创伤外科电子杂志,2015,1(1):45-48
4弓开弦.影响急性颅脑损伤患者预后的相关因素分析[J].临床医学研究与实践,2017,2(14):12-13
5吴莎莎,李红娟,饶高峰.康复治疗对2型糖尿病并发脑卒中患者日常生活自理能力改善作用观察[J].中国基层医药,2017,24(19):2914-2917
6 Bonville DJ,Ata A,Jahraus CB,et al.Impact of preinjury warfarin and antiplatelet agents on outcomes of trauma patients[J].Surgery,2011,150(4):861-868
7 Grandhi R,Harrison G,Voronovich Z,et al.Preinjury warfarin,but not antiplatelet medications,increases mortality in elderly traumatic brain injury patients[J].J Trauma Acute Care Surg,2015,78(3):614-621
8 Tollefsen MH,Vik A,Skandsen T,et al.Patients with moderate and severe traumatic brain injury:impact of preinjury platelet inhibitor or warfarin treatment[J].World Neurosurgery,2018,114:e209-217
9 Peck KA,Calvo RY,Schechter MS,et al.The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury[J].J Trauma Acute Care Surg,2014,76(2):431-436
10刘强,宋平.GOS和ADL评价不同术式及时间窗治疗高血压脑出血的疗效[J].中西医结合心脑血管病杂志,2017,15(4):489-491
11冯玉建.原发性脑干损伤60例救治体会[J].中国实用医药,2014,9(26):127-128