严重创伤失血性休克患者复苏前凝血纤溶功能的变化及其意义

目的探讨严重创伤失血性休克患者复苏前凝血纤溶功能的变化及其意义。方法108例严重创伤失血性休克患者按照简明损伤标准与损伤严重度评分（AIS-ISS）分为S1组（ISS〈25分）69例和S2组（ISS≥25分）39例；根据创伤后至开始有效复苏时间分为5组：A组（≤30min）35例、B组（30min〈t≤2h）28例、C组（2h〈t≤4h）20例、D组（4h〈t〈8h）15例、E组（t≥8h）10例。分别检测各组凝血酶原时间（PT）、部分活化凝血酶原时间（APTT）、纤维蛋白原浓度（FB）、D-二聚体（D-D）浓度、抗凝血酶活性（AT：A）和纤溶酶原活性（PLG：A）；并与对照组（健康体检者）进行对照。结果A、D、E3组PT、APTT、FB、D-D、AT：A、PLG：A值与对照组比较差异均有统计学意义（P〈0．05或P〈0．01）；B组D-D、AT：A、PLG：A值与对照组比较差异均有统计学意义（P〈0．05或P〈0．01），而PT、APTT、FB值与对照组比较差异均无统计学意义（均P〉0．05）；C组PT、D-D、AT：A、PLG：A值与对照组比较差异均有统计学意义（P〈0．05或P〈0．01），而APTT、FB值与对照组比较差异均无统计学意义（均P〉0．05）；S1、S2组PT、APTT、FB、D-D、AT：A、PLG：A值与对照组比较差异均有统计学意义（P〈0．05或P〈0．01），S2组PT、FB、D-D、AT：A、PLG：A值与S2组比较差异均有统计学意义（均P〈0．01）。结论严重创伤失血性休克后凝血纤溶系统出现明显异常，并随休克时间的长短而有不同的改变；凝血纤溶系统的异常可能与创伤严重程度有关。

Significance of the Change of Coagulation and Fibrinolysis Function in Severe Traumatic Patients with Hemorrhagic Shock before Fluid Resuscitation

Objective To explore the significance of the change of coagulation and fibrinolysis function in severe traumatic patients with hemorrhagic shock before fluid resuscitation. Methods One hundred and eight traumatic patients with hemorrhagic shock were divided into S1 （69 cases） and S2 （39 cases）groups according to abbrebiated injury score and injury severity score （AIS- ISS） ,and different groups （A,B,C,D,E）were established according to the continuance time of shock before fluid resuscitation. Prothrombin time （PT）, activated partial thromboplastin time （AAPT）, Fibrinogen（FB）, D-dimmer, AT ： A and PLG ： A were tested respectively in different groups, and compared with control group. Results Compared with control group, PT, APTT, FB, D-D,AT ： A and PLG ： A in groups （A,D,E）were different significantly（P〈0.05 or P〈0.01）. D-D,AT ： A and PLG ： A in group B were different significantly compared with control group （P〈0.05 or P〈0.01）, but there were no difference between the two groups as for PT, APTT and FB（P〉0.05,respectively）. PT,D-D,AT ： A and PLG ： A in group C were different significantly compared with control group （P〈0.05 or P〈0.01）,but APTT and FB were not different statistically（P〉0.05,respectively）. PT,APTT,FB,D-D,AT ： A and PLG ： A in groups （S1 and S2） were different significantly compared with control group （P〈0. 05 or P〈0.01）. PT,FB,D- D,AT ： A and PLG ： A in groups S2 were different significantly compared with group S1 （P〈 0. 01, respectively）. Conclusion The abnormal of coagulation and fibrinolysis function could occur in severe traumatic patients with hemorrhagic shock, and different change can be observed in different time after hemorrhagic shock. The abnormal of coagulation and fibrinolysis function maybe related to the degree of severity of trauma.