多发伤患者凝血功能的改变及临床意义

Changes of coagulation functions in the patients with multiple trauma and its clinical meanings

目的研究多发伤患者凝血功能的改变,及其对病情严重度和预后的判断价值。方法以ICU收治的107例多发伤患者作为研究对象,按有无并发多脏器功能障碍综合征(MODS)分为MODS组和非MODS组;分为生存组和死亡组;按各凝血指标分为正常组和异常组。测定血浆凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(Fg)、凝血酶时间(TT)、D-二聚体(D-dimer)、纤维蛋白(原)降解产物(FDP)及血小板(PLT),同时记录患者的急性生理和慢性健康状况评分(APACHE)Ⅲ。结果MODS组FDP、D-dimer明显高于非MODS组,PLT明显低于非MODS组,PT、APTT明显较非MODS组延长。死亡组D-dimer明显高于生存组,PLT明显低于生存组,TT、APTT、PT明显较生存组延长。凝血相关指标异常组APACHEⅢ评分明显高于正常组。结论多发伤患者凝血功能出现显著异常,其中PT、APTT、D-Dimer、PLT对病情严重度及预后有重要的判断价值。

Objective To investigate the relationship between the severity, prognosis of the multiple traumatic patients and the coagulation dysfunction. Methods 107 cases of multiple traumatic patients were divided into 2 groups： multiple organ dysfunction syndrome（MODS） and non - MODS according to the criteria of MODS; the survival group and death group according to the outcome; the normal group and abnormal group according to coagulation markers. Platelets and five coagulation markers were measured and APACHE Ⅲ scores were determined at the admission day. The differences of coagulation markers between the two groups were analyzed and the relationship between the coagulation markers and APACHEⅢ scores were studied. Result The level of platelet was lower and the level of D - dimer, fibrin degradation product （FDP） were dramatically higher in MODS group than those of non - MODS group, while prothrombin time（PT） and activated partial thromboplastin time（APTr） were obviously prolonged. The level of platelet was lower and the level of D - dimer was dramatically higher in death group than those of survival group, while PT, APTr and TT were obviously prolonged. APACHE Ⅲscores of patients whose PT, APTr, TT, D -dimer and platelet were abnormal were dramatically higher than those of patients with normal markers. Conclusion The coagulation dysfunction of multiple traumatic patients is associated with the severity and prognosis of the illness.