多发伤患者凝血功能指标在病情程度和预后判断中的作用研究

目的 探讨多发伤患者凝血指标对病情程度及预后判断的意义.方法 选择我院2013年6月至2015年1月ICU收治的82例多发性创伤患者为研究对象.根据是否发生创伤性凝血功能异常(TIC)分为TIC组(n=37)与非TIC组(n=45);并根据伤后14 d预后情况分为死亡组(n=25)与存活组(n=57).入选者在入院6h内完成血小板(Plt)、纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)的检测;入院12 h内完成对入选者创伤严重度评分(ISS),24 h内完成急性生理和慢性健康评分(APACHEⅡ);伤后6个月对TIC组与非TIC组中存活者进行随访,进行诺丁汉健康量表(NHP)评价.结果 TIC组PLt、FIB水平低于非TIC组,PT、APTT、TT均高于非TIC组,差异有统计学意义(均P＜0.01);TIC组ISS评分、APACHEⅡ评分均高于非TIC组,差异有统计学意义(均P＜0.05);伤后14 dTIC组死亡16例(43.24％),非TIC组9例(20％),2组比较差异有统计学意义(P＜0.05);6个月后NHP评分TIC组(97.85 ±23.17)分,非TIC组(86.24±20.16)分,2组比较差异有统计学意义(P＜0.05).死亡组PLt、FIB水平低于存活组,PT、APTT、TT、入院时ISS评分、APACHEⅡ评分均高于存活组,差异有统计学意义(均P＜0.01).结论 多发性创伤患TIC几率较高,凝血指标对于多发伤病情程度、预后评价及成功诊治具有重要参考价值.

Study on the effects of blood coagulation function on the severity and prognosis of the patients with multi-trauma

Objective To explore the value of trauma-induced blood coagulation dysfunction in the evaluation of severity and prognosis of the patients with multi-trauma.Methods Eighty-two cases of multi-trauma patients admitted into the ICU of the department from June 2013 to January 2015 were chosen as the research subjects.The patients were divided into the trauma-induced coagulopathy (TIC) group(n =37)and the non-trauma-induced coagulopathy (NTIC) group (n =45),by depending on whether or not they had coagulopathy,and they were further divided into the death group (n =25) and the survival group(n =57),in view of prognosis 14 days after injury.Indices such as platelet (Plt),fibrinogen (FIB),prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time(TT) were measured within 6 hours after admission into hospital.Injury severity scores (ISS) of the subjects were evaluated 12 hours after admission,acute physiological and chronic health evaluationⅡ (APACHE Ⅱ)were performed within 24 hours after admission.Six mouths after injury,the survivors in both the TIC group and the NTIC group had medical follow-ups,and scores of Nottingham health profile (NHP) were evaluated.Results The levels of PLt and FIB in the TIC group were lower than those in the NTIC group,and the levels of PT,APTT and TT in the TIC group were all higher than those in the NTIC group,with statistical significance (P ＜ 0.01).The scores of ISS and APACHE Ⅱ in the TIC group were all significantly higher than those in the NTIC group,also with statistical significance(P ＜0.05).Fourteen days after injury,16 cases in the TIC group died (43.24％),and in the NTIC group 9 cases died (20％).Statistical significance could be noted when comparisons were made between the 2 groups (P ＜ 0.05).Six months after injury,the NHP scores of the TIC group were (97.85 ±23.17),while those of the NTIC group were (86.24 ±20.16).Statistical significance could also be noted when comparisons were made between the 2 groups(P ＜ 0.05).The levels of PLt and FIB in the death group were all higher than those in the survival group.The scores of PT,APTT and TT in the death group were higher than those in the survival group,and the scores of ISS and APACHE Ⅱ at the time of admission in the death group were all significantly higher than those in the survival group.Statistical significance could be noted,when comparisons were made between the 2 groups (P ＜ 0.01).Conclusion There was a high probability for those patients with multi-trauma to have TIC.Coagulation index was of significant importance to the diagnosis and prognosis of the patients with multiple injuries.