严重创伤失血性休克患者凝血功能测定与输血的临床分析

Clinical analysis of transfusion and blood coagulation test in severe trauma patients with hemorrhagic shock

目的探讨严重创伤失血性休克患者凝血功能变化及输血等有关问题。方法将69例严重创伤(AIS≥3或ISS≥16)病例,按照ISS值分为ISS<25组与ISS≥25组,分别监测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)与纤维蛋白原(FIB),血红蛋白(HB)、血细胞比容(HCT)及血小板计数(PLT);记录创伤后失血量与输血量;用SPSS软件进行统计学处理。结果总治愈率为84.1%,凝血象异常占76.8%(53/69),成分输血占总输血量的72.3%。ISS≥25组与ISS<25组比较,PT时间明显延长(P=0.016),失血量、输血总量显著增加(P=0.028,P=0.004)。结论严重创伤失血性休克患者损伤越严重对凝血功能影响越大;在积极进行快速液体复苏的同时,需要外科确定性手术止血;在补充血液丢失时须充分考虑纠正凝血功能异常。

Objective To explore the changes of blood coagulation function and strategies of blood transfusion in the patients with severe trauma. Methods Sixty-nine patients with severe trauma(AIS≥3 or ISS≥16)from August 2003 to December 2004 were analyzed retrospectively. These patients were divided into 2 groups ( ISS<25 and ISS≥25). PT,APTT,TT,FIB,HB,HCT,PLT of the cases were detected,and the volume of blood loss and blood transfusion were recorded respectively. Statistical analysis was done by SPSS software. Results The rate of disfunction of blood coagulogram accounted for 76.8% (53/69). The component blood transfusion rate was (72.3%). The PT in patients with ISS≥25 was significantly prolonged than those patients with ISS<25((P=0.016)),the volume of blood loss and blood transfusion in patients with ISS≥25 was significantly higher than those patients with ISS<25(P=0.028,P=0.004 respectively). Conclusion The more serious injuries is,the greater affection in blood coagulation function is. At the time of quickly fluid resuscitation,the definite surgical hemostasis is needed. The coagulation disfunction should be corrected promptly during fluid resuscitation and transfusion.