急性创伤性血胸凝血功能异常的临床研究

Clinical study of blood coagulation and fibrinolysin in acute traumatic hemothorax

目的探讨急性创伤性血胸患者的凝血功能变化特点及与出血量严重程度、预后的关系。方法1将126例急性创伤性血胸患者分为小量、中量、大量3组,测定患者入院当时、24 h、及72 h的血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、血小板(BPC)值,并与43例健康对照组比较。2入院、24 h、72 h将各组血胸的凝血指标异常发生情况进行比较。结果1各型血胸中入院时PT、APTT、FIB、BPC均有异常,随着胸腔出血量增大,PT、APTT均升高,FIB、BPC降低。2入院24 h各组血胸的凝血指标异常发生率无明显差异。3入院72 h大量血胸组患者的凝血指标异常发生率和中、小量血胸组相比有明显差异。结论小量血胸患者的凝血功能无异常改变,中、大量血胸患者的凝血功能异常,且与血胸量程度相关,大量血胸组患者的入院72 h凝血指标异常发生率显著提高,可为急性创伤性血胸的治疗和判断预后提供依据。

Objective To investigate the characteristics of blood coagulation and fibrinolysin in acute traumatic hemothorax and to evaluate its relationship with bleeding volume and prognosis. Methods （1） Divided 126 cases into three groups： a little amount, medium amount and the large amount, according to the bleeding volume of acute traumatic hemothorax. Detected the levels of plasma prothrombin time （PT）, active part plasma prothrombin （APTT）, Fibrinogen （FIB）, and thrombocyte （BPC） at patients registered the hospital, after 24 hours and 72 hours respectively, and compared with the healthy control group. （2） Compared the abnormal level of the coagulant index between 24 hours and 72 hours group. Results （1） PT, APTT, FIB and BPC were abnormal in all kinds of acute traumatic hemothorax, when the patients registered the hospital. More bleeding voulum, higher level of PT and APTT were found, but reverse of the level of FIB and BPC. （2） Patients enrolled in the 24 hours group had no significant difference in the rate of the abnormal coagulation parameters.（3）There were great changes between the large amount and the other groups. Conclusion There were obvious changes of PT, APTT, FIB and BPC in the groups of medium and large amount bleeding, except the little amount group, and the changes were related to the volume of bleeding. For the coagulation parameters was elevated significantly in the patients with large amount hemothorax （after 72 hours）, PT, APTT, FIB and BPC could be good indexes to judge the prognosis of patients suffered from acute traumatic hemothorax.