严重闭合性胸部创伤患者早期凝血功能变化比较

Clinical characteristics of early blood coagulation function in patients with simple and complex severe closed chest trauma

目的探讨各类严重闭合性胸部创伤患者的早期凝血功能变化,以提高该类患者的早期识别及干预。方法回顾性研究2013年1月—2016年6月伤后24h内成都大学附属医院急诊收入ICU及胸外科的胸部创伤患者的临床资料,根据简明损伤分级90版(AIS-90),纳入AIS≥3分的严重闭合性胸部创伤患者,以是否输血、是否为单纯性严重闭合性胸部创伤、是否ISS>25分以及是否GCS<9分分组,比较入院24h内凝血功能变化差异。结果共纳入228例患者,死亡15例,死亡组ISS评分均高于存活组(t=14.49,P<0.01),GCS评分均低于存活组(t=14.44,P<0.01)。在严重闭合性胸部创伤患者中,D-二聚体(D-D)和纤维蛋白原降解产物(FDP)在多发伤组、ISS评分>25分组及GCS<9分组均高于相应的单纯胸部创伤组、ISS﹤25分组及GCS>9分组(P﹤0.01);凝血酶原时间(PT)ISS>25分组中,高于ISS≤25分组(P<0.01)。结论合并多发伤的严重闭合性胸部创伤患者在受伤早期,D-D和FDP明显升高,且该类患者多具有GCS和ISS高评分特点,是临床筛选高危创伤患者并指导进行早期干预的重要指标。

Objective To improve the early identification and intervention for the patients with severe closed thoracic trauma by discussing the changes of blood coagulation function in these patients. Methods A retrospective study was carried out in 228 patients with severe closed chest trauma,who were admitted to hospital within24 h with AIS≥3 according to AIS-90. They were divided into different groups on the basis of whether with blood transfusion,multiple injury,ISS 25 and GCS 9. The differences of coagulation function 24 h after admission were compared. Results Among the 228 patients,15 cases died. The ISS score in the death group was higher than that in the survival group（t = 14. 49,P 0. 01）; GCS was lower than that in the survival group（t = 14. 44,P 0. 01）.D-D and fibrinogen degradation products（FDP） in the severe closed chest trauma patients with multiple trauma group,ISS 25 group and GCS 9 group were higher than those of their corresponding control groups,（P 0. 01）;PT in the ISS 25 group was higher than that in ISS ≤25 group. Conclusion Among severe closed chest trauma patients with multiple injury,D-D and FDP were significantly increased in the early period and the patients had high GCS and ISS score. D-D and FDP was an important index for clinical screening of high-risk patients with trauma and guidance for early intervention.