乌司他丁和氨甲环酸对严重创伤早期凝血功能的影响
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摘要
目的探讨乌司他丁和氨甲环酸对严重创伤早期凝血功能的影响。方法严重创伤早期患者174例,分为三组:乌司他丁组54例,入院时给予乌司他丁50万单位及血浆600ml,3h后重复乌司他丁50万单位;氨甲环酸组58例,入院时给予氨甲环酸1.0g及血浆600ml;联合组62例,入院时给予乌司他丁50万单位、氨甲环酸0.75g以及血浆600ml,3h后重复乌司他丁50万单位。于入院时、治疗3h、24h和5d检测凝血酶原时间(PT)、APTT、纤维蛋白原(Fg)、血栓调节蛋白(TM)和蛋白C水平,观察三组治疗结果。结果治疗3h,氨甲环酸组PT和APTT较乌司他丁组缩短(P<0.05),联合组蛋白C较其他两组升高(P<0.05)。治疗3h和24h,联合组PT和APTT较其他两组缩短(P<0.05),氨甲环酸组和联合组Fg较乌司他丁组升高,TM较乌司他丁组降低,联合组较氨甲环酸组改善更明显(P<0.05)。联合组较乌司他丁组和氨甲环酸组康复比例高,死亡和长期住院比例低(P<0.05)。结论严重创伤早期,联合应用乌司他丁和氨甲环酸能够更好地改善患者的凝血功能,提高救治成功率。
Objective To investigate the effect of ulinastatin and tranexamic acid on the coagulation function in early severe trauma.Methods A total of 174 cases with early severe trauma was divided into three groups.The patients in groups of A(54cases)and B(58cases)were given ulinastatin 500 000 units and tranexamic acid 1.0g,respectively,as well as plasma 600 ml.The patients in group C(62cases)were given ulinastatin 500 000 units,tranexamic acid 0.75 g and plasma600 ml.A repeated dose of ulinastatin 500 000 units was injected at three hours later in groups of A and C.The levels of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fg),thrombomodulin(TM)and protein C were detected on admission and on the 3rd,24 th hour and5 th day after treatment.The outcomes of treatment were observed and compared among three groups.Results The times of PT and APTT were shorter in group B than those in group A on the 3rd hour after treatment(P<0.05).The level of protein C was higher in group C than that in groups of A and B on the 3rd hour after treatment(P<0.05).The times of PT and APTT were shorter in group C than those in groups of A and B on the 3rd and 24 th hour after treatment(P<0.05).The level of Fg was higher and TM was lower in groups of B and C than those in group A on the 3rd and 24 th hour after treatment,which were changed more obviously in group C(P<0.05).The percentages of the cases with better recovery and less mortality and long term hospital stay were higher in group C than those in groups of A and B(P<0.05).Conclusion Combined use of ulinastatin and tranexamic acid in patients with severe trauma in early stage can improve the coagulation function and success rate of treatment.
Objective To investigate the effect of ulinastatin and tranexamic acid on the coagulation function in early severe trauma.Methods A total of 174 cases with early severe trauma was divided into three groups.The patients in groups of A(54cases)and B(58cases)were given ulinastatin 500 000 units and tranexamic acid 1.0g,respectively,as well as plasma 600 ml.The patients in group C(62cases)were given ulinastatin 500 000 units,tranexamic acid 0.75 g and plasma600 ml.A repeated dose of ulinastatin 500 000 units was injected at three hours later in groups of A and C.The levels of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fg),thrombomodulin(TM)and protein C were detected on admission and on the 3rd,24 th hour and5 th day after treatment.The outcomes of treatment were observed and compared among three groups.Results The times of PT and APTT were shorter in group B than those in group A on the 3rd hour after treatment(P<0.05).The level of protein C was higher in group C than that in groups of A and B on the 3rd hour after treatment(P<0.05).The times of PT and APTT were shorter in group C than those in groups of A and B on the 3rd and 24 th hour after treatment(P<0.05).The level of Fg was higher and TM was lower in groups of B and C than those in group A on the 3rd and 24 th hour after treatment,which were changed more obviously in group C(P<0.05).The percentages of the cases with better recovery and less mortality and long term hospital stay were higher in group C than those in groups of A and B(P<0.05).Conclusion Combined use of ulinastatin and tranexamic acid in patients with severe trauma in early stage can improve the coagulation function and success rate of treatment.
引文
[1]Global Burden of Disease Study 2013Collaborators.Global,regional,and national incidence,prevalence,and years lived with disability for 301acute and chronic diseases and injuries in 188countries,1990-2013:a systematic analysis for the Global Burden of Disease Study 2013[J].Lancet,2015,386(9995):743-800.
[2]Palmer L,Martin L.Traumatic coagulopathy-part 2:resuscitative strategies[J].J Vet Emerg Crit Care(San Antonio),2014,24(1):75-92.
[3]Frith D,Goslings JC,Gaarder C,et al.Definition and drivers of acute traumatic coagulopathy:clinical and experimental investigations[J].J Thromb Haemost,2010,8(9):1919-1925.
[4]Cohen MJ,Kutcher M,Redick B,et al.Clinical and mechanistic drivers of acute traumatic coagulopathy[J].J Trauma and Acute Care Surg,2013,75(1Suppl 1):S40-S47.
[5]Levy JH,Dutton RP,Hemphill JC 3rd,et al.Multidisciplinary approach to the challenge of hemostasis[J].Anesth Analg,2010,110(2):354-364.
[6]Johansson PI,Srensen AM,Perner A,et al.Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma?An observational study[J].Crit Care,2011,15(6):R272.
[7]Hess JR,Brohi K,Dutton RP,et al.The coagulopathy of trauma:a review of mechanisms[J].J Trauma,2008,65(4):748-754.
[8]Brohi K,Cohen MJ,Ganter MT,et al.Acute coagulopathy of trauma:hypoperfusion induces systemic anticoagulation and hyperfibrinolysis[J].J Trauma,2008,64(5):1211-1217.
[9]Jacob M,Kumar P.The challenge in management of hemorrhagic shock in trauma[J].Med J Armed Forces India,2014,70(2):163-169.
[10]Bailey AM,Baker SN,Weant KA,et al.Tranexamic acid for trauma-related hemorrhage[J].Adv Emerg Nurs J,2014,36(2):123-131.
[11]Porta CR,Nelson D,McVay D,et al.The effects of tranexamic acid and prothrombin complex concentrate on the coagulopathy of trauma:an in vitro analysis of the impact of severe acidosis[J].J Trauma Acute Care Surg,2013,75(6):954-960.
[12]林思涵,詹思延.乌司他丁应用概况的可视化研究[J].中华危重病急救医学,2013,25(12):754-759.
[13]沈叶菊,陈晓兵,石远峰,等.乌司他丁对急性肺损伤大鼠肺TLR4及TREM-1和TREM-2表达的影响[J].江苏医药,2015,41(17):2002-2005.
[14]Tanaka R,Fujita M,Tsuruta R,et al.Urinary trypsin inhibitor suppresses excessive generation of superoxide anion radical,systemic inflammation,oxidative stress,and endothelial injury in endotoxemic rats[J].Inflamm Res,2010,59(8):597-606.
[15]张艳杰,潘景业,林锡芳,等.乌司他丁对ICU危重患者凝血功能障碍的治疗作用[J].实用医学杂志,2009,25(7):1132-1135.
[2]Palmer L,Martin L.Traumatic coagulopathy-part 2:resuscitative strategies[J].J Vet Emerg Crit Care(San Antonio),2014,24(1):75-92.
[3]Frith D,Goslings JC,Gaarder C,et al.Definition and drivers of acute traumatic coagulopathy:clinical and experimental investigations[J].J Thromb Haemost,2010,8(9):1919-1925.
[4]Cohen MJ,Kutcher M,Redick B,et al.Clinical and mechanistic drivers of acute traumatic coagulopathy[J].J Trauma and Acute Care Surg,2013,75(1Suppl 1):S40-S47.
[5]Levy JH,Dutton RP,Hemphill JC 3rd,et al.Multidisciplinary approach to the challenge of hemostasis[J].Anesth Analg,2010,110(2):354-364.
[6]Johansson PI,Srensen AM,Perner A,et al.Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma?An observational study[J].Crit Care,2011,15(6):R272.
[7]Hess JR,Brohi K,Dutton RP,et al.The coagulopathy of trauma:a review of mechanisms[J].J Trauma,2008,65(4):748-754.
[8]Brohi K,Cohen MJ,Ganter MT,et al.Acute coagulopathy of trauma:hypoperfusion induces systemic anticoagulation and hyperfibrinolysis[J].J Trauma,2008,64(5):1211-1217.
[9]Jacob M,Kumar P.The challenge in management of hemorrhagic shock in trauma[J].Med J Armed Forces India,2014,70(2):163-169.
[10]Bailey AM,Baker SN,Weant KA,et al.Tranexamic acid for trauma-related hemorrhage[J].Adv Emerg Nurs J,2014,36(2):123-131.
[11]Porta CR,Nelson D,McVay D,et al.The effects of tranexamic acid and prothrombin complex concentrate on the coagulopathy of trauma:an in vitro analysis of the impact of severe acidosis[J].J Trauma Acute Care Surg,2013,75(6):954-960.
[12]林思涵,詹思延.乌司他丁应用概况的可视化研究[J].中华危重病急救医学,2013,25(12):754-759.
[13]沈叶菊,陈晓兵,石远峰,等.乌司他丁对急性肺损伤大鼠肺TLR4及TREM-1和TREM-2表达的影响[J].江苏医药,2015,41(17):2002-2005.
[14]Tanaka R,Fujita M,Tsuruta R,et al.Urinary trypsin inhibitor suppresses excessive generation of superoxide anion radical,systemic inflammation,oxidative stress,and endothelial injury in endotoxemic rats[J].Inflamm Res,2010,59(8):597-606.
[15]张艳杰,潘景业,林锡芳,等.乌司他丁对ICU危重患者凝血功能障碍的治疗作用[J].实用医学杂志,2009,25(7):1132-1135.