摘要
目的 探讨肢体创伤后机体凝血系统改变的有关指标检测的临床意义。方法 将肢体创伤病人 49例分为 3组 :Ⅰ组 (n=2 2 ) :为肢体单处开放性骨折 ,未作急诊显微外科技术修复。Ⅱ组 (n =1 2 ) :肢体单处软组织缺损或肢体单处骨折伴主干血管损伤 ,需急诊行显微外科技术修复者。Ⅲ组 (n =1 5) :肢体两处以上开放性骨折伴休克或伴有头、胸、腹等处损伤。三组均检测 :血小板计数 (PLC) ,活化部分凝血活酶时间 (APTT)、凝血酶原时间 (PT)、凝血酶时间 (TT)和纤维蛋白原定量(FIB)。结果 Ⅰ、Ⅱ组各期的检测指标基本相接近 ,仅Ⅱ组中的FIB术前轻度增高 ,伤后 2 4h恢复正常。Ⅲ组与Ⅰ、Ⅱ组相比 :APTT下降 ,FIB显著增高 ,PLC尽管在正常范围内 ,但已经明显高于Ⅰ、Ⅱ组各期 ,以上三项指标差异有统计意义 (P<0 .0 5)。结论 对于一般创伤病人急诊行显微外科技术修复是可行的且是安全的 ,但对肢体严重创伤病人由于创伤后机体处于一种高凝状态 ,不适应急诊行显微外科手术 。
Objective To study the clinical significance of detection of change in coagulative system after injuries of extremities.Methods Forty-nine patients with open injuries to the extremities were divided into 3 groups.Group Ⅰ (n=22):The patients with only one open fracture to the extremities and they did not undergo microsurgery; Group Ⅱ(n=12):The patients with single soft tissue defect or only open injury to the extremities accompanied by the wound of important blood vessel, an emergency microsurgery had to be done;Group Ⅲ(n=15):The patients suffered from multiple open fractures of the extremities with traumatic shock or head, chest and abdomen injuries . The blood coagulative system in three groups was evaluated by testing platelet count (PLC), Active part thrombin time (APTT), prothrombin time (PT),thrombin time (TT),FIBrinogen(FIB).Results The date in group Ⅱis almost as same as in group I, only FIB in group Ⅱ lightly increased before operation, then they returned to normal 24 h after injury. Group Ⅲ:At different periods after trauma, there was significant evidence of APTT decline accompanied by high increase of FIB and PLC,Although the normal date for PLC.The three changes showed significant difference (P<0.05).Conclusion An emergency microsurgery could be saftely performed in patents with ordinary open injury;however it should not be operated the emergency microsurgery in cases of severe injures; as hyperxoagulation status would follow after injuries. It is good for subemergent repair.
出处
《骨与关节损伤杂志》
2002年第1期43-45,共3页
The Journal of Bone and Joint Injury
基金
江山市科委资金赞助项目 (项目号 :2 0 0 1 2 9)
