急诊骨折患者血小板及凝血功能临床应用的评价

Evaluation of clinical application of platelet and coagulation function of the fractured patients

目的探讨急诊骨折创伤患者血小板(PLT)及凝血功能与患者病情变化及预后的关系。方法选择急救120所送骨折创伤患者82例,按受伤程度分成3组:A组(n=33):肢体单处骨折;B组(n=24):肢体单处开放性骨折;C组(n=25):肢体2处及2处以上骨折伴血管损伤或脏器损伤。3组分别于入院时、术后24h、术后3d采集外周静脉血,检测PLT、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)及D-二聚体(D-D)。结果A、B组PLT、APTT、FIB检测项目均在正常范围,两组均与对照组比较差异无统计学意义(P>0.05)。C组PLT、FIB与对照组比较明显增高,差异有统计学意义(P<0.01),C组APTT与A组及B组各期相比明显降低,差异有统计学意义(P<0.01)。A组各期D-D检测在正常范围内,而在B组及C组中明显增高,与对照组比较差异有统计学意义(P<0.01),且B组各期与C组各期比较,C组各期有明显增高。结论骨折创伤特别是多发性创伤患者机体处于高凝状态,纤溶增强。检测PLT和凝血功能对临床骨折患者静脉栓塞及弥漫性血管内凝血(DIC)的发生提供监测指标。

Objective To explore the blood platelet and cogulation function associated with the changes of illness condition and prognosis for the emergency patients suffered from fracture. Methods 82 examples of bone--fracture wounded patients delivered by first aid 120 were selected and divided, according to the degree of injury, into three groups： A group （n=33）.. single-limb fracture. B group （n= 24）： limb open fracture. C group （n= 25）： two and more than two places of limb fractures with vascular injury or organ injury. After 24h and 3 days of operation, peripheral venous blood of the three groups was collected respectively, and the platelets, prothrombin time （PT）, activated partial thromboplastin time （APTT）, thrombin time （TT）, fibrinogen （FIB） and D-dimer （D-D） were tested at the same time. Results The PLT, APTT, FIB test items of GroupA and GroupB were all in the normal range, and compared with those in the control group, there was no significance （P〉0.05）. The PLT and FIB of Group C, compared with the control group, was significantly higher （P〈0. 01）, and the APTT, compared with each period of Group A and Group B, was significantly decreased （P〈0.01）. The D-D testing phases of Group A were within the normal range, while in Group B and Group C significantly increased, but compared with the normal control group, it was statistically significant （P（0.01）, and compared Group B with Group C, the period of Group C significantly increased. Conclusion The trauma fracture, especially in multiple trauma patients with hypercoagulable state body, will enhance fibrinolysis. Detection of platelet and coagulation function of patients in clinical fracture vein thrombosis and disseminated intravascular coagulation （DIC） can provide for the occurrence of fracture.