急诊多发性外伤患者发生凝血病的危险因素
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摘要
目的探讨急诊多发性外伤患者发生凝血病的危险因素。方法回顾性研究分析该院2010年5月—2013年4月收治的84例急诊多发伤患者的相关资料,记录ISS、APACHEⅡ值、血常规、血气分析和凝血功能等指标。根据实验室检查结果,将患者分成凝血病组和对照组。将两组病人间APACHEⅡ值、低体温及低灌注比例、ISS等指标,分析TIC的危险因素,并建立多因素回归方程。结果 17例(20.2%)患者符合TIC的诊断,死亡率显著高于对照组。且凝血病组的ISS、低体温和组织低灌注发生率、伴有严重创伤性脑损伤的比例明显高于对照组,而GCS评分、血小板计数、血红蛋白浓度、红细胞压积均显著低于对照组。GCS≤8、碱缺失≥6和血小板计数是多发性外伤患者收治入EICU时发生创伤性凝血病的独立预测因素。结论 TIC与全身损伤严重程度、伴有严重创伤性脑损伤、休克及低体温有关,容易造成不良的预后情况。
Objective To investigate the risk factors of TIC. Methods 84 severe trauma patients were retrospectively analyzed. ISS,APACHE Ⅱscore,coagulation function,routine blood test,biochemical test,and blood gas assay were completed for each patient. Hypoperfusion was defined as vasoactive agents usage,or base deficit( BD) ≥6 or shock index≥1. Patients were divided into coagulopathy group and control group according to coagulation function. ISS,APACHE II score,the occurrence of hypothermia and hypoperfusion were compared between the two groups. The risk factors of TIC were analyzed,and the multivariate logistic regression equation was formulated. Results Base deficit ≥6,GCS≤8,and platelet counts were considered as the independent risk factors involved in trauma induced coagulopathy according to logistic regression in this study. Conclusions TIC correlates well with ISS core,severe traumatic brain injury,shock and hypothermia,and results in high mortality.
Objective To investigate the risk factors of TIC. Methods 84 severe trauma patients were retrospectively analyzed. ISS,APACHE Ⅱscore,coagulation function,routine blood test,biochemical test,and blood gas assay were completed for each patient. Hypoperfusion was defined as vasoactive agents usage,or base deficit( BD) ≥6 or shock index≥1. Patients were divided into coagulopathy group and control group according to coagulation function. ISS,APACHE II score,the occurrence of hypothermia and hypoperfusion were compared between the two groups. The risk factors of TIC were analyzed,and the multivariate logistic regression equation was formulated. Results Base deficit ≥6,GCS≤8,and platelet counts were considered as the independent risk factors involved in trauma induced coagulopathy according to logistic regression in this study. Conclusions TIC correlates well with ISS core,severe traumatic brain injury,shock and hypothermia,and results in high mortality.
引文
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[5]潘光华,徐庆余,郑旭东,等.早期补充凝血底物对严重创伤合并创伤性凝血病治疗的临床研究[J].中国现代医生,2011,49(34):124-125,127.
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[10]徐少文,张茂.重视对创伤性凝血病的认识与防治[J].中华急诊医学杂志,2009,18(4):344-347.
[2]徐善祥,王连,杨俭新,等.ICU中创伤性凝血病的影响因素与临床意义[J].中华急诊医学杂志,2012,21(9):1007-1011.
[3]姚建英,王永芳,彭媛,等.重组人凝血因子Ⅶa在创伤性凝血病中的应用[J].苏州医学,2011,34(1):41-42.
[4]王瑞兰,陈德昌.限制性液体复苏和允许性低血压对严重创伤救治的影响[J].中华创伤杂志,2012,28(4):289-290.
[5]潘光华,徐庆余,郑旭东,等.早期补充凝血底物对严重创伤合并创伤性凝血病治疗的临床研究[J].中国现代医生,2011,49(34):124-125,127.
[6]钱永兵,陆健,田锐,等.重组活化Ⅶ因子对严重创伤合并创伤性凝血病的作用[J].中华急诊医学杂志,2011,20(6):597-599.
[7]张茂,王连,干建新,等.创伤性凝血病防治的研究进展[J].中华创伤杂志,2010,26(3):286-288.
[8]陈德昌.创伤性凝血病的发病机制和救治原则[J].中华创伤杂志,2009,25(9):771-773.
[9]Mae Leod JB.Trauma and coagulopathy:a new paradigm to consider[J].Arch Surg,2008,143(8):797-801.
[10]徐少文,张茂.重视对创伤性凝血病的认识与防治[J].中华急诊医学杂志,2009,18(4):344-347.