严重创伤患者中急性创伤性凝血病与深静脉血栓形成关系探讨

Acute traumatic coagulopathy is associated with deep vein thrombosis in severely traumatic patients

目的研究创伤患者下肢深静脉血栓（DVT）形成的危险因素，并探讨急性创伤性凝血病（ATC）与DVT形成的关系。方法回顾性收集上海交通大学附属第六人民医院急性创伤急救中心EICU2014年1月至12月收治的创伤患者资料，记录年龄、性别、体质量指数、创伤严重度评分（ISS）、创伤机制、损伤部位、人院时国际标准化比率（INR）、DVT发生率等指标。根据INR将患者分为凝血病组和非凝血病组（对照组），比较两组间DVT的发生率。结果入选创伤患者200例，60例（30％）患者出现ATC，87例（43．5％）患者发生DVT。凝血病组DVT发生率显著高于非凝血病组（71．7％眠31．4％，P〈0．01）。Logistic回归分析结果显示凝血病组DVT发生率是非凝血病组的5．74倍（OR=5．74，95％CI：2．80～11．74，P〈0．01）。在次危重（9≤ISS〈16）患者中，凝血病组DVT发生率的增加更加显著（OR=9．80，95％CI：2．09～45．90，P=0．004）。同时脊髓损伤（OR=4．96，95％CI：1．17～20．95，P=0．029）和下肢长骨骨折（OR=4．80，95％CI：1．70～13．5，P=0．003）是下肢DVT形成的独立危险因素。结论伤后24h内收住EICU的严重创伤患者，ATC的发病率较高。伴有ATC的创伤患者下肢DVT的发病率显著增加，尤其在次危重组（9≤ISS〈16）患者中更为明显。同时脊髓损伤和下肢长骨骨折是下肢DVT形成的独立危险因素。

Objective To investigate the risk factors of deep vein thrombosis （DVT） as well as the association between acute traumatic coagulopathy （ATC） and DVT. Methods A retrospective observational study was carried out during the 12 month period in 2014 in emergency intensive care unit （EICU） of acute trauma center of Shanghai Jiao Tong University Affiliated Sixth People＇ s Hospital. Data including age, gender, body mass index, injury severity score （ISS）, mechanism of injury, injury sites, international normalized ratio （INR） and DVT of each patient were recorded. Patients were divided into ATC group and non-ATC group according to INR to compare the incidence of DVT. Results A total of 200 trauma patients were enrolled in this cohort. Sixty （30%） patients suffered from ATC. And eigbty-seven patients （43.5%） were subjected to DVT. Patients with ATC had a significant higher incidence of DVT （71.7% vs. 31.4% , P 〈0. 01 ）. Multiple logistic regression revealed that patients in ATC group were highly associated with DVT in the magnitude of more than five fold （OR =5.74, 95% CI： 2. 80 - 11.74, P 〈 0. 01 ） compared with non-ATC group. It was more significant （ OR = 9.80, 95% CI： 2. 09 - 45.90, P = 0. 004） in patients with lesser severe trauma （9 ≤ ISS 〈 16）. Meanwhile, spinal cord injury and long-bone fracture of lower extremities were independent risk factors for the development of DVT. Conclusions Severe trauma patients admitted to EICU within 24 hours post-injury have a high incidence of ATC. And those patients with ATC have a significantly higher incidence of DVT, especially in lesser severe trauma （9 ≤ ISS 〈 16）. Spinal cord injury and long-bone fracture of lower extremities were independent risk factors for developing DVT.