严重创伤患者凝血纤溶特点分析

Features of the coagulation and fibrinolysis in patients with severe trauma

目的探讨严重创伤患者凝血纤溶功能障碍,寻求反映创伤患者凝血纤溶功能障碍的敏感指标。方法选取54例严重创伤患者,分别在手术前及手术后第1天和第5天测定其血浆凝血酶-抗凝血酶复合物(TAT)、凝血酶原裂解片段(F1+2)、D-二聚体、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)5项指标水平,并与正常对照组(50例)进行比较。结果手术前患者组与对照组相比F1+2、TAT、D-二聚体差异均有统计学意义(P<0.05);手术后第1天这3项指标均达3次结果峰值(P<0.01),手术后第4天3项指标均稍有下降,但差异无统计学意义;3次测定结果中,APTT、PT结果与正常对照组差异均无统计学意义。结论严重创伤患者F1+2、TAT、D-二聚体升高,提示患者处于高凝状态,并有继发性纤溶亢进,在反映严重创伤患者凝血纤溶功能障碍中,这些分子指标优于常规凝血象检查。

Objective To find the sensitive index to reflect the coagulation and fibrinolysis dysfuncation in severe trauma patients. Methods Observe the dynamic data of F1＋2 ,TAT and D-dimer,APTT,PT Fib in vein blood of 54 patients. Results Compared with the control group,F1＋2 ,TAT and D-dimer increased obviously before operation（P〈0.05） ,and they reached the peak one day after operation,then they decreased a little but showed no significant difference with 4 days after operation. The levels of APTT and PT showed no difference with the control group. Conclusion F1＋2 ,TAT and D-dimer are superior to APTT,PT in reflection of the coagulation and fibrinolysis dysfuncation in severe trauma patients.