严重创伤患者凝血与纤溶功能异常的临床研究

Clinical studies of coagulation and fibrinolysis dysfunction of severe trauma patients

目的探讨严重创伤患者凝血与纤溶指标变化及其临床意义。方法 150例严重创伤患者按损伤严重程度分为S1组(69例)、S2组(51例)、S3组(30例),按损伤部位分为A1组(34例)、A2组(59例)、A3组(57例),以50例健康者为对照组,比较各组凝血与纤溶指标。结果研究组各损伤程度亚组PLT、D-D、Fbg、PT、TT、APTT水平与对照组比较差异均有统计学意义(P<0.05)。S1组、S2组、S3组各指标水平变化趋势经Spearman检验,PLT、D-D、PT、TT、APTT与损伤严重程度呈正相关(P<0.05),Fbg与损伤程度呈负相关(P<0.05)。研究组各损伤部位亚组PLT、D-D、Fbg、PT、TT、APTT水平与对照组比较差异均有统计学意义(P<0.05)。PLT:A1组骨折患者较对照组下降,A2组颅脑损伤及A3组多发伤患者较对照组显著升高;D-D:A1组、A2组、A3组患者均较对照组升高,A2组低于A1组、A3组;Fbg:A1组、A3组较对照组下降,A2较对照组升高;PT:A1组、A2组、A3组患者均较对照组升高,A2组高于A1组、A3组;TT:A1组、A2组、A3组患者均较对照组升高,A3组最高,A1组最低;APTT:A1组、A2组、A3组患者均较对照组升高,A1组最高,A2组最低。结论严重创伤患者的血液处于高凝和纤溶亢进状态,并随病情严重程度加重,不同部位损伤凝血和纤溶指标变化不同与发病机制相关,其中D-D与Fbg适于作为临床筛查指标。

Objective To investigate clinical significance of coagulation and fibrinolysis dysfunction of severe trauma patients. Methods There were 150 cases of patients with severe trauma injury, were divided into S1 group （69 cases）, S2 （51 eases）,S3 group（30 cases）,at the site of injury were divided into A1 group （34 cases）,group A2 （59 cases）, A3 group （57 cases）, and 50 healthy control group, compared groups of coagulation and fibfinolysis indicators. Re- sults The study group the degree of injury subgroup PLT, DD, Fbg,PT,TT, APTT level with the control group,the difference was statistically significant （P 〈0.05）.PLT, DD, PT,3T,APTT and injury severity were positively correlated （P 〈 0.05）. Changes of all of the index levels of S1 ,S2,S3 groups were tested by Spearman,and Fbg degree and in jury was a negative correlation（P 〈 0.05）. The research group,the site of injury sub-group of the PLT, DD, Fbg, PT, TT, APTT level with the control group differences was statistically significant （P 〈 0.05）. PLA： fracture cases of A1 group was lower than control group, eranioeerebral injury cases of A2 group and multiple injuries cases of A3 group were higher than control group. D-D：A1, A2, A3 groups were higher than control group, and A2 group was lower than A1 and A3 groups. Fbg：A1, A3 groups were lower than control group, and A2 group was higher than control group. PT：A1, A2, A3 groups were higher than control group, and A2 group was higher than A1 and A3 groups. TT： A1, A2, A3 groups were higher than control group, and A3 group was highest, A1 group was lowest. APTT：A1, A2, A3 groups were higher than control group, and A1 group was highest,A2 group was lowest. Conclusion The blood of patients with severe trauma in hypereoagulability and hyperfibrinolysis state, and with the increased Severity of the disease,the different the site damage coagulation and fibrinolysis indicators change different pathogenesis,in- cluding the DD and Fbg suitable as the clinical screening indicators.