创伤早期全身炎症反应综合征血液生化指标及血气变化分析

Analysis of blood biochemistry and arterial blood gas of systemic inflammatory response syndrome in the early time after trauma

目的探讨创伤早期发生全身炎症反应综合征(SIRS)的外周血液生化指标及血气变化特点,提高对伤情的早期判断和救治水平。方法从2003年8月-2004年2月我科收治的创伤患者中随机抽取88例,按AIS-ISS90进行创伤评分,分为重伤组和轻伤组,总结两组患者入院时的体温、脉搏、呼吸频率、血糖、外周血白细胞、血红蛋白及动脉血气参数(PaO2、PaCO2、HCO3-、AG),经统计学处理比较两组间上述指标的差异,并比较SIRS发生率及预后的差异。结果88例患者中,创伤早期符合SIRS诊断标准者49例,其中12例在轻伤组,37例在重伤组。重伤组患者脉搏、呼吸频率、白细胞计数、血糖、AG及SIRS发生率明显高于轻伤组;PaO2、HCO3-明显低于轻伤组;PaCO2>45mmHg或<35mmHg的发生率明显高于轻伤组(P<001);两组间体温、血红蛋白无明显差别(P>005)。重伤组中有13例发生了多器官功能不全综合征(MODS),死亡2例。轻伤组无MODS病例,无死亡病例。结论应用AIS-ISS90进行创伤评分结合SIRS相关外周血液生化指标及血气变化的检测有利于对创伤患者病情的早期判断和及时处理。

AIM: To explore the variation of blood biochemistry and arterial blood gas of patients with systemic inflammatory response syndrome (SIRS) in the early time after trauma and improve the diagnosis and first aid. METHODS: Eighty-eight patients with trauma from August 2003 to February 2004 were divided into two groups by their AIS-ISS90 score. The data of temperature, pulse, respiratory rate, white blood cell counts, Hb, blood glucose and arterial blood gas (PaO 2, PaCO 2, HCO 3 -, AG) were collected and compared with each group by statistic methods. RESULTS: Of the 88 patients, 49 underwent SIRS, 12 in light trauma group (ISS≥16) and 37 in severe trauma group (ISS<16). Compared with light trauma group, the data of pulse, respiratory rate, white blood cell counts, blood glucose, AG and rate of SIRS of severe trauma group were higher, PaO 2 and HCO 3 - were lower and the cases of PaCO 2>45 mmHg or <35 mmHg were more ( P <0 01). The data of temperature and Hb had not significant difference between two groups ( P >0 05). 13 patients had MODS in severe trauma group and 2 died while none had MODS or died in light trauma group. CONCLUSION: Application of AIS-ISS90 and SIRS-related blood biochemistry and arterial blood gas is beneficial for the diagnosis and treatment for patients in the early time after trauma. [