首次纤维蛋白原与白蛋白水平对预测危重腹部创伤患者预后的分析

Predictive value analysis of first fibrinogen and albumin levels after admission for prognosis of patients with severe abdominal trauma

目的探讨急诊危重腹部创伤患者入院后首次纤维蛋白原(Fib)与白蛋白(Alb)水平对预后的预测价值。方法回顾性分析遵义医学院附属医院急诊科2014年1月至2017年8月收治的84例危重腹部创伤患者的临床资料。依据急诊抢救室首次测定的Fib水平将患者分为Fib<1.0 g/L组(12例)、Fib 1.0~2.0 g/L组(43例)和Fib>2.0 g/L组(29例)。观察各组患者血清Alb、创伤严重度评分(ISS)、红细胞和血浆输注量、输血率及预后的变化;并评价Fib<1.0 g/L及Alb<20 g/L对预后的预测价值。结果随着Fib水平的升高,ISS、红细胞和血浆输注量、输血率及病死率均逐渐降低;Fib 1.0~2.0 g/L和Fib>2.0 g/L两组ISS、红细胞和血浆输注量、输血率及病死率均低于Fib<1.0 g/L组〔ISS(分):22.88±4.86、24.40±7.26比27.67±8.45,红细胞输注量(U):8.46±6.50、5.59±3.60比11.92±5.55,血浆输注量(mL):1197.22±325.31、1010.76±295.50比1492.31±382.17,输血率:88.37%(38/43)、55.17%(16/29)比100.00%(12/12),24 h内病死率:2.33%(1/43)、3.45%(1/29)比33.33%(4/12)〕;而随着Fib水平的升高Alb明显升高,Fib 1.0~2.0 g/L和Fib>2.0 g/L两组Alb明显高于Fib<1.0 g/L组(g/L:28.92±6.13、34.05±6.46比20.48±6.40,均P<0.05)。84例患者死亡10例,总病死率为11.90%;其余患者预后良好。Fib<1.0 g/L及Alb<20 g/L可作为临床判断病情及预后的重要指标,其敏感度、特异度、95%可信区间(95%CI)分别为40%、89.19%、1.58~2.14和50%、90.54%、27.94~31.04。结论危重腹部创伤患者早期Fib与Alb下降与病情严重程度有关,Fib及Alb越低病情越重,早期病死率越高;Fib<1.0 g/L及Alb<20 g/L可作为临床判断病情及预后的重要指标;Fib替代治疗以及补充Alb能为危重腹部创伤患者的救治提供更多选择方案。

Objective To explore the predictive value of the first time fibrinogen(Fib)and albumin(Alb)levels after admission for the prognosis of emergent critically ill patients with acute abdominal trauma.Methods The clinical data of 84 patients with severe abdominal trauma admitted to the department of emergency of the Affiliated Hospital of Zunyi Medical University from January 2014 to August 2017 were analyzed retrospectively.According to the first time Fib levels after admission,the patients were divided into three groups:Fib<1.0 g/L(12 cases),Fib 1.0-2.0 g/L(43 cases)and Fib>2.0 g/L(29 cases)groups.At the same time,the changes of serum Alb,injury severity score(ISS),erythrocyte and plasma infusion volumes,blood transfusion rate and prognosis were observed in the three groups;to evaluate the predictive values of Fib<1.0 g/L and Alb<2.0 g/L for prognosis.Results Along with the increase of Fib level,the ISS,erythrocyte and plasma infusion volumes,blood transfusion rate and mortality were all decreased gradually;the ISS,red blood cell and plasma infusion volumes,blood transfusion rates and mortalities in Fib 1.0-2.0 g/L group and Fib>2.0 g/L group were all lower than those in Fib<1.0 g/L group[ISS:22.88±4.86,24.40±7.26 vs.27.67±8.45,erythrocyte infusion volume(U):8.46±6.50,5.59±3.60 vs.11.92±5.55,plasma infusion volume(mL):1197.22±325.31,1010.76±295.50 vs.1492.31±382.17,transfusion rate:88.37%(38/43),55.17%(16/29)vs.100.00%(12/12),24 hours fatality rate:2.33%(1/43),3.45%(1/29)vs.33.33%(4/12)];while with the increase of Fib level,Alb increased significantly,the Alb contents in Fib 1.0-2.0 g/L group and Fib>2.0 g/L group were significantly higher than that in Fib<1.0 g/L group(g/L:28.92±6.13,34.05±6.46 vs.20.48±6.40,all P<0.05).Ten of the 84 patients died,with an overall fatality rate of 11.90%;the rest of the patients had a good prognosis.Fib<1.0 g/L and Alb<20 g/L can be used as important indicators to judge the clinical condition and prognosis in patients with acute abdominal trauma,their sensitivity,specificity and 95%confidence interval(95%CI)were 40%,89.19%,1.58-2.14 and 50%,90.54%,27.94-31.04,respectively.Conclusions Early decrease of Fib and Alb levels in critically ill patients with severe abdominal trauma is related to the severity of the disease,and the lower the Fib and Alb levels,the more severe the disease,the higher the early mortality.Fib<1.0 g/L and Alb<20 g/L can be used as important indicators to judge the clinical condition and prognosis in patients with acute abdominal trauma.Fib alternative therapy and Alb supplement can provide more options for the treatment and rescue of such patients.