头胸部多发伤对凝血功能的影响

Influence of polytrauma with head and thoracic injuries on coagulation function

目的:探讨头胸部多发伤对机体凝血功能的影响。方法:头胸部多发伤48例(头胸外伤组),同期收治胸外伤81例(胸外伤组)、头外伤138例(头外伤组),比较3组治疗经过、疗效、出血情况及手术比例,观察凝血异常率与病程的关系以及迟发颅内出血的主要时间段。结果:与头外伤组比较,头胸外伤组颅内血肿量多、迟发颅内出血的比例及病死率高(P<0.05);与胸外伤组比较,头胸外伤组胸腔闭式引流比例及病死率高,引流量大,引流时间长(P<0.05);与胸外伤组、头外伤组比较,头胸外伤组凝血酶时间、凝血酶原时间、活化部分凝血活酶时间及凝血酶原国际标准化比率延长,血浆纤维蛋白原及血小板计数降低,差异均有统计学意义(P<0.05)。入院前3 d凝血异常率逐渐升高,之后下降。头胸外伤组、头外伤组迟发颅内出血主要发生于入院后第2天和第3天。结论:头、胸部多发伤相互影响,加重了凝血功能异常与出血倾向,入院后第2天和第3天为迟发颅内出血的高峰期。

Objective To investigate the influence of polytrauma with head and thoracic injuries on coagulation function.Methods The treatment,efficacy,bleeding and surgery rates were observed and compared in 48 cases of polytrauma with head and thoracic injuries（PT group）,81 cases of chest trauma（CT group） and 138 cases of head trauma（HT group）.The relationship was studied between the rate of coagulopathy and the course,and the period of delayed intracranial hemorrhage was observed.Results The intracranial hematoma volume,the rate of delayed intracranial hemorrhage and the death rate in PT group were significantly higher than those in HT group（P0.05）.The portion of closed thoracic drainage and the death rate were higher,the drainage volume was larger and the drainage time was longer in PT group than those in HT group（P0.05）.The thrombin time,prothrombin time,activated partial thromboplastin time were longer and international normalized ratio was higher,and fibrinogen and platelet were lower in PT group than those in HT and CT groups（P0.05）.A gradual increase was found in the rate of clotting abnormalities in the first 3 days after admission followed by a gradual decline.Delayed intracranial hemorrhage in both PT group and CT group mainly occurred on the second and third day.Conclusion With interactions,polytrauma with head and thoracic injuries aggravates coagulation dysfunction and bleeding tendency.The peak of delayed intracranial hemorrhage is in the second and third day.