摘要
目的 分析多发伤患者发生创伤性凝血病（TC）的危险因素及预后的影响因素.方法 回顾性分析多发伤患者180例的临床资料,根据患者是否发生急性TC分为TC组和对照组,TC组患者根据预后情况分为死亡组和存活组,分析年龄、性别、多发伤原因、血常规指标[血红蛋白（Hb）、红细胞比容（Hct）,血小板（Plt）]、凝血指标[凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）]、动脉血气指标、损伤严重程度评分（ISS）、急性生理和慢性健康评分Ⅱ（APACHEⅡ）评分、格拉斯哥昏迷评分（GCS评分）、合并重型颅脑损伤（STBI）、输血量、使用升压药对TC及预后的影响.结果 180例多发伤患者共有52例发生TC,发生率为28.89％.52例TC患者中21例死亡,病死率为40.38％.128例对照组患者中12例死亡,病死率为9.38％,TC组病死率明显高于对照组,差异有统计学意义（χ2=23.749,P〈0.01）.单因素分析结果显示,TC组和对照组合并STBI比例、使用升压药比例、GCS评分≤6分比例、Hb、Hct、Plt、ISS、APACHEⅡ评分、输血量差异均有统计学意义（χ2=45.779、28.281、15.626,t=5.148、6.183、13.366、6.248、9.146、8.353,均P〈0.01）.logistic回归分析结果显示,GCS评分≤6分、合并STBI、Plt计数水平是多发伤患者发生TC的独立危险因素.结论 急诊多发伤患者易出现TC,具有较高病死率,影响TC的独立危险因素为GCS评分≤6分、合并STBI、Plt计数水平,影响TC患者预后的独立危险因素为GCS评分≤6分、合并STBI.
Objective To analyze the risk factors and the prognostic factors of acute traumatic coagulopathy （TC） in patients with polytrauma. Methods The clinical data of 180 patients with multiple trauma were analyzed. All the patients were divided into TC group and control group according to whether acute TC was occurring or not. The TC group were divided into death group and survival group according to the prognosis. The influence of age,gender, multiple trauma cause, blood index [ hemoglobin （Hb）, hematocrit （ Hct ）, platelet （ Pit ） ], coagulation index [ prothrombin time （ PT）, activated partial thromboplastin time （AFFF） ], arterial blood gas index, injury severity score （ ISS）, acute physiology and chronic health score Ⅱ （APACHE Ⅱ ）, Glasgow Coma Scale （GCS） score, complicated with severe head injury（ STBI）, blood transfusion, use of antihypertensive drugs on TC and prognosis were analyzed. Results There were 52 patients with TC in 180 patients with polytrauma,which accounted for 28.89%. There were 21 deaths in 52 patients with TC,which accounted for 40.38%. There were 12 deaths in 128 patients without TC,which accounted for 9.38%. The death rate of the TC patients were significantly higher than that of the non - TC patients, the difference was statistically significant（ χ2 = 23. 749, P 〈 0.01 ）. The differences of the ratio of Consolidate STBI, the ratio of using boost drugs, GCS ≤ 6, Hb, Hct, Ph, ISS, APACHE Ⅱ, blood transfusion between the TC group and control group were statistically significant（ χ2 = 45. 779,28. 281,15. 626, t = 5. 148,6. 183,13. 366,6. 248,9. 146, 8. 353 ,all P 〈0.01 ）. logistic regression analysis showed that GCS ≤6 points, complicated with STBI, Pit count were independent risk factors for acute TC in patients with polytrauma. Conclusion Emergency patients with multiple injuries are prone to TC, which has higher mortality. The GCS ≤6 points, complicated with STBI and Ph count are the independent risk factors for TC. The GCS ≤ 6 points, complicated with STBI are the independent risk factors for prognosis of TC patients.
作者
徐杰
Xu Jie.(Department of Emergency, the First People＇s Hospital of Wuyi County, Zhejiang 321200, China)
出处
《中国基层医药》
CAS
2018年第9期1188-1192,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
多处创伤
创伤性凝血病
预后
因素分析
统计学
Multiple trauma
Traumatic coagulopathy
Prognosis
Factor analysis, statistical
