初始凝血指标在多发伤患者病情严重程度评价中的应用

Application of initial coagulation index in the evaluation of severity of multiple trauma patients

目的探讨初始凝血指标对多发伤患者病情严重程度的评价意义。方法2017年8月—2018年2月宁夏医科大学总医院急诊科收治多发伤患者183例,男性135例,女性48例;年龄1-83岁,平均40.3岁。按损伤严重程度评分(ISS)不同分为多发伤组69例(ISS<16分)与严重多发伤组114例(ISS≥16分),通过回顾性分析患者一般临床资料、初始凝血指标、GCS评分等指标变化与ISS评分的相关性,采用多因素Logistic回归分析多发伤患者病情严重程度的独立危险因素。结果严重多发伤组[纤维蛋白质(FIB)、D-二聚体(DD)、DD/FIB、GCS评分]和脉压差与多发伤组相比,差异有统计学意义(P<0.05)。APTT、DD和DD/FIB与ISS评分呈正相关,GCS评分与ISS评分呈负相关(P<0.05)。多因素Logistic回归分析结果表明,性别、DD、DD/FIB及GCS评分是多发伤患者病情严重程度的独立危险因素(P<0.05)。结论凝血指标DD、DD/FIB及GCS评分可以用于判断多发伤患者的病情严重程度,对多发伤的早期临床诊断和治疗具有一定价值。

Objective To investigate the correlation between early coagulation parameters and severity of trauma patients.Methods A total of 183 patients with trauma were treated from Aug.2017 to Feb.2018.According to the ISS score,they were divided into two groups:69 cases(ISS<16)in the multiple injuries group and 114 cases(ISS≥16)in the severe injury group.Patient s general clinical data,ISS score,initial coagulation index,GCS score,other indicators changes and ISS score correlation were retrospectively analyzed.Multivariate Logistic regression was used to analyze independent risk factors for the severity of trauma patients.Results There were significant differences in FIB,DD,DD/FIB,GCS scores,pulse pressure differences between the severely injured and the lightly injured groups(P<0.05).APTT,DD and DD/FIB were positively correlated with ISS scores,and GCS scores were negatively correlated with ISS scores(P<0.05).Multivariate logistic regression analysis showed that gender,DD,DD/FIB and GCS scores were independent risk factors for the severity of multiple trauma patients(P<0.05).Conclusion DD,DD/FIB and GCS scores can be used to judge the severity of trauma patients,and have certain value for early clinical diagnosis and treatment of trauma.