不同复苏方案对严重多发伤患者创伤性凝血障碍的影响

Effects of traumatic coagulopathy with different recovery programs for severe multiple trauma patients

目的探讨不同复苏方案对严重多发伤患者创伤性凝血障碍的影响。方法回顾性地选取2008年1月至2013年10月于该院就诊的312例严重多发伤患者,根据复苏方式的不同将患者分为观察组和对照组两组,每组各156例。对照组采取传统的复苏方案,观察组采取损伤控制性复苏方案救治,对比两组患者的临床疗效及并发症、住院时间等情况。结果观察组患者的低体温时间、凝血功能时间、酸中毒时间分别为(9.25±1.33)h、(13.52±5.96)h、(15.61±4.67)h,均明显低于对照组的(20.32±1.98)h、(31.23±12.15)h、(30.09±5.78)h;观察组患者的出血量为(1986.25±22.65)mL,相比于对照组的(2674.99±31.26)mL明显降低;观察组患者创伤性凝血病的发病率及死亡率均显著低于对照组;住院时间与对照组相比明显缩短。差异均具有统计学意义(P<0.05)。结论对严重多发伤合并凝血功能障碍的患者而言,采用损伤控制性复苏方案救治在缩短凝血功能障碍、低体温及酸中毒等的时间、降低创伤后并发症的发生率及死亡率、提高救治效果,缩短住院时间等方面相比于传统的复苏方案具有显著的优越性。

Objective To investigate effects of traumatic coagulopathy with different recovery programs for severe multiple trauma patients. Methods Three hundred and twelve cases of severe multiple trauma patients treated from January 2008 to October 2013 in Tongling People's Hospital were selected retrospectively,and were assigned into observation group and control group according to the way of recovery,156 cases in each group. The control group took a traditional recovery program,while the observation group took damage control resuscitation treatment program. Clinical efficacy and complications,length of stay etc. for two groups of patients were compared.Results Hypothermia time,coagulation time,acidosis time of patients in observation group were( 9. 25 ± 1. 33) h,( 13. 52 ± 5. 96) h,( 15.61 ±4.67) h,significantly lower than( 20.32 ±1.98) h,( 31.23 ±12.15) h,( 30.09 ±5. 78) h in the control group. Bleeding volume of patients in observation group was( 1986. 25 ± 22. 65) mL was significantly lower than( 2674. 99 ± 31. 26) mL in the control group. Traumatic coagulopathy morbidity and mortality rates of patients in observation group were significantly lower than those in control group,and hospital stay was significantly shorter compared with the control group. The differences were statistically significant( P <0. 05). Conclusions For patients with severe multiple injuries combined coagulopathy,damage control resuscitation program has significant advantages in shortening coagulopathy,hypothermia and acidosis time,reducing the incidence of post-traumatic complications and mortality,improving the efficacy,shortening hospital stay etc. compared with the traditional recovery program.