严重创伤患者早期凝血功能变化及与血浆血栓调节蛋白、蛋白C的关系

Early change of blood coagulation in severe trauma patients and its relation with plasma thrombomodulin and protein C

目的探讨严重创伤患者早期凝血功能变化及与血浆血栓调节蛋白（thrombomodu—lin，TM）、蛋白c水平的关系及其临床意义。方法选择早期多发伤患者64例，按严重创伤程度评分（ISS）分为重伤组（ISS≥16分）和轻伤组（ISS〈16分），比较分析各组凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）变化，同时检测血浆TM和蛋白c水平，分析与凝血功能变化的相关性。另选择30例健康人为正常对照组。比较分析死亡和生存患者血浆TM和蛋白c水平的变化。结果重伤组PT和APTT较轻伤组及正常对照组明显延长（P〈0．05），与血浆TM和蛋白c的水平变化均有明显的相关性（P〈0．05）。死亡患者血浆TM水平明显高于生存患者，蛋白c明显低于生存患者。结论严重创伤患者早期出现凝血功能异常，与血浆TM和蛋白c的活化相关，血浆TM和蛋白c水平对预后有重要的预测价值。

Objective To investigate the early change of blood coagulation in severe trauma patients and its relationship with plasma levels of thrombomodulin （TM） and protein C. Methods Sixtyfour multiple trauma patients early admitted to the emergency department were divided into two groups according to the injury severity score （ISS）, severe trauma group （ISS≥ 16 points） and slight trauma group （ ISS 〈 16 points）. Blood specimens were obtained immediately upon their arrival at hospital to comparatively analyze the changes of prothrombin time （PT） and activated partial thromboplastin time （APTT） in both groups. Meanwhile, plasma levels of TM and protein C were measured and analyzed for discussing their relationship with changes of blood coagulation. Another 30 healthy persons were taken as the control group. Levels of plasma TM and protein C between the death and survival were comparatively analyzed as well. Results PT and APTT in the severe trauma group （ISS ≥ 16 points） were significantly longer than those in the slight trauma group （ISS 〈 16 points） and the control group （P 〈 0.05 ）, with significant correlation with plasma TM and protein C levels （ P 〈 0.05 ）. Plasma TM level in the death group was significantly higher than that in the survival group, but protein C level in the death group was significantly lower than that in the survival group. Conclusions Coagulation abnormalities presenting early after severe trauma are correlated with activation of plasma TM and protein C. Levels of plasma TM and protein C demonstrate significant role in prediction of the prognosis in patients with severe trauma.