摘要
目的探讨严重创伤患者不同时相凝血功能紊乱的临床特征。方法对2015年9月-2019年7月解放军联勤保障部队第908医院重症医学科收治的279例严重创伤患者进行回顾性分析,根据入科时的凝血状况分为普通创伤组(n=187)、创伤性凝血病组(n=44)和创伤性弥散性血管内凝血(DIC)组(n=48)。收集各组入科2 h内的血红蛋白(HGB)、血小板计数(PLT)、纤维蛋白原(FIB)、部分活化凝血酶原时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、D-二聚体(DD)、抗凝血酶Ⅲ(ATⅢ)、纤维蛋白原降解产物(FDP)以及血栓弹力图(TEG)参数[凝血反应时间(R)、血块形成速率(K)、血块形成动力学(α角)、血块最大强度(MA)和凝血综合指数(CI)],比较3组上述各指标,采用ROC曲线分析FIB诊断创伤性凝血病的诊断效能。结果与普通创伤组的APTT[30.8(27.3,35.7)s]、PT[14.0(12.7,15.1)s]、K时间[2.3(1.8,3.4)min]比较,创伤性凝血病组的APTT[44.2(34.1,58.4)s]、PT[18.1(17.2,19.1)s]、K时间[3.3(2.1,7.1)min]明显延长(P<0.05)。与普通创伤组的α角[57.8(47.1,65.2)°]、MA[57.8(47.1,65.2)mm]、CI[–1.9(–4.3,0.3)]比较,创伤性凝血病组的α角[48.3(35.3,59.6)°]、MA[51.0(34.7,58.8)mm]、CI[–4.2(–7.9,–1.3)]明显减小(P<0.05)。与创伤性凝血病组的DD[2.9(0.9,7.3)mg/L]、FDP[17.3(5.4,60.5)mg/L]比较,创伤性DIC组的DD[23.1(10.4,33.3)mg/L]和FDP[79.2(38.2,147.4)mg/L]显著升高(P<0.05)。与创伤性凝血病组的R[7.2(5.8,8.8)min]、K[3.3(2.1,7.1)min]比较,创伤性DIC组的R[10.4(8.1,16.7)min]、K[7.9(4.6,18.1)min]显著延长(P<0.05)。与创伤性凝血病组的PLT[117(85,152)×109/L]、FIB[1.66(1.20,2.96)g/L]、α角[48.3°(35.3°,59.6°)]、MA[51.0(34.7,58.8)mm]和CI[–4.2(–7.9,–1.3)]比较,创伤性DIC组的PLT[75(38,105)×109/L]、FIB[0.91(0.64,1.61)g/L]、α角[32.3°(18.6°,43.9°)]、MA[33.6(23.2,44.9)mm]和CI[–11.0(–18.7,–6.9)]均显著降低(P<0.05)。结论严重创伤时凝血紊乱的不同时相分别以纤溶亢进、低纤维蛋白原血症和血小板减少为主要特征,可为凝血复苏分级策略提供依据。
Objective To explore the clinical characteristics of coagulation dysfunction at different stages in trauma patients.Methods Retrospective analysis of 279 trauma patients admitted to the Intensive Critical Unit of 908th Hospital of Chinese PLA from September 2015 to July 2019.The patients were divided into non-traumatic coagulopathy group(NTC group,n=187),traumatic coagulopathy group(TC group,n=44)and traumatic disseminated intravascular coagulation group(TDIC group,n=48)according to the coagulation status at admission.Data on injury severity score(ISS),Acute Physiology and Chronic Health Evaluation score(APACHEⅡscore),hemoglobin(HGB),platelet count(PLT),fibrinogen(FIB),activated partial thromboplastin time(APTT),prothrombin time(PT),and thrombin time(TT),D-dimer,antithrombinⅢ(ATⅢ),fibrinogen degradation product(FDP),and thromboelastographic(TEG)parameters were collected within 2 hours at admission and analyzed statistically.Results The APTT,PT and K times were significantly prolonged in TC group compared with the NTC group(P<0.05).Theα,MA and CI significantly decreased in TC group as compared with the NTC group(P<0.05).The DD and FDP were significantly increased in the TDIC group compared with the TC group.The HGB,PLT,FIB,α,MA and CI were significantly reduced in TDIC group as compared with TC group.Conclusion Hyperfibrinolysis,hypofibrinogenemia and thrombocytopenia are the main characteristics of coagulation disorders at different phases of severe trauma,which provides a basis for graded coagulation and resuscitation strategy.
作者
林青伟
宋景春
曾庆波
钟林翠
余甜
胡艳晶
LIN Qing-wei;SONG Jing-chun;ZENG Qing-bo;ZHONG Lin-cui;YU Tian;HU Yan-jing(Department of Intensive Care Unit,the 908th Hospital of Chinese PLA Joint Logistic Support Force,Nanchang 330002,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2019年第12期1030-1034,共5页
Medical Journal of Chinese People's Liberation Army
基金
江西省卫生健康委员会科技计划(20195684)~~
关键词
创伤
凝血病
弥散性血管内凝血
血栓弹力图
trauma
coagulopathy
disseminated intravascular coagulation
thromboelastography
