急诊重症创伤患者发生创伤性凝血病的危险因素分析

张晓燕; 朱晶; 王瑞兰; 金卫

doi:10.13201/j.issn.1009-5918.2020.07.007

急诊重症创伤患者发生创伤性凝血病的危险因素分析

- 1 上海交通大学附属第一人民医院急诊危重病科(上海, 200240);
- 2 上海交通大学附属第一人民医院输血科

详细信息

通讯作者: 金卫,E-mail:jw1230123@126.com

中图分类号: R473.6

收稿日期: 2020-03-19

Analysis of risk factors of acute and severe trauma occurs trauma induced coagulopathy

- 1 Department of ICU, the First People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200240, China;
- 2 Department of Blood Transfusion, the First People's Hospital Affiliated to Shanghai Jiaotong University

More Information

Corresponding author: JIN Wei, E-mail: jw1230123@126.com

Received Date: 19 March 2020

摘要

摘要: 目的:探讨创伤性凝血病(TIC)发生的危险因素,为临床医师早期识别干预凝血病提供依据。方法:回顾性分析2015-09-2018-09期间我院就诊的急诊重症创伤患者的临床资料,根据是否发生TIC将其分为2组,研究组(急诊重症创伤患者并发TIC)和对照组(急诊重症创伤患者未并发TIC),分别为40例和108例。分别记录患者伤后24 h内的基本资料及实验室指标,分析急诊重症创伤患者发生TIC的危险因素。结果:2组比较,患者的性别、年龄、创伤原因、损伤部位比较差异无统计学意义(P>0.05)。研究组入院时失血性休克、心搏骤停、低体温的发生率明显高于对照组(P<0.05)。研究组损伤严重度(ISS)评分及急性生理学与慢性健康状况评分系统(APACHⅡ)评分明显高于对照组,格拉斯哥昏迷(GCS)评分低于对照组(P<0.05)。2组患者机械通气时间及总住院时间比较差异无统计学意义(P>0.05),但研究组ICU住院时间及病死率高于对照组(P<0.05)。研究组血红蛋白压积、血小板总数、乳酸水平与对照组比较差异有统计学意义(P<0.05)。对具有统计学意义的指标进行筛查,进行多因素Logistic回归分析,结果显示ISS评分、血小板总数和乳酸水平是急诊重症创伤患者发生TIC的独立危险因素。国际标准化比值(INR)的ROC曲线下面积为0.861,提示INR对TIC的预后有较好的辨别能力。结论:ISS评分、乳酸水平和创伤后血小板总数是TIC发生的独立危险因素,INR对TIC的预后有较好的辨别能力,识别高危因素,并及时监测相关凝血指标,对提高急诊重症患者生存率,降低住院时间有重要的临床指导意义。
- 创伤性凝血病 /
- 创伤严重程度 /
- 血小板 /
- 乳酸
Abstract: Objective: To investigate the risk factors of trauma induced coagulopathy(TIC),and to provide evidence for clinicians to identify and intervene clotting disease early. Method: Retrospective analyzing the clinical data of emergency patients with severe trauma treating in the First People's Hospital Affiliated to Shanghai Jiaotong University from September 2015 to September 2018 were retrospective analyzed. The data were divided into two groups based on whether the patients suffered TIC. The research group including 40 patients with acute and severe trauma complicating TIC, and the control group including 108 patients with acute and severe trauma not complicating TIC. The basic information and the laboratory index of patients within 24 hours after injury were Recorded,and the risk factors of TIC in acute and severe trauma were analyzed. Result: Comparing two groups, the difference of patients' gender, age, trauma causes, trauma area between the two groups are not statistically significant(P>0.05). The incidence of hemorrhagic shock, cardiac arrest and hypothermia in research group on admission are significantly higher than the control group(P<0.05). The ISS score and APACHⅡ score of the research group are significantly higher than the control group, but the GCS score is lower(P<0.05). The time of mechanical ventilation and the total time stay in in the hospital between two groups are not statistically significant, but the time stay in ICU and the mortality of the research group are higher than the control group(P<0.05). The hemoglobin accretion, total platelet count and lactic acid level between two groups are statistically significant. Screening and performing multi-factor logistic regression analysis on the statistically significant indicator resulting that ISS score, total platelet count and lactic acid level are independent risk factor of acute and severe trauma occurring TIC. The proportion under INR'S ROC curve is 0.861 prompting INR have better discrimination on the prognosis of TIC.Conclusion: ISS score, lactic acid level and the total platelet count after trauma are the independent risk factors of TIC. INR have better discrimination on the prognosis of TIC. Identifying risk factors and monitoring related clotting indicators timely have important clinical significance on improving survival rates and reducing length of stay in hospital of critically patients.
- trauma induced coagulopathy /
- ISS score /
- platelet /
- lactic acid

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