急诊重症创伤患者发生创伤性凝血病的危险因素及预后影响因素分析

Analysis of Prognostic Influencing Factors and Risk Factors of Trauma Induced Coagulopathy in Emergency Patients with Severe Trauma

目的:研究急诊重症创伤患者发生创伤性凝血病(TIC)的危险因素及预后影响因素。方法:选择2018年1月-2020年1月闽清县总医院急诊中心收治的重症创伤且并发TIC患者80例(研究组),同期重症创伤但无TIC患者80例(对照组)。所有患者入院后即完善所有临床资料信息,于患者转入ICU时采集外肘静脉血样,检测患者凝血指标、炎症指标及血常规指标。比较两组凝血、炎症、血常规指标。并对TIC的影响因素进行分析,根据预后将研究组患者分为存活组和死亡组,比较存活组和死亡组的血常规指标。结果:研究组C反应蛋白(CRP)、血浆活化蛋白C(APC)、D-二聚体(D-D)水平均高于对照组(P<0.05),纤维蛋白原(FIB)、血小板计数(PLT)、血红蛋白(Hb)水平均低于对照组(P<0.05)。Logistic回归分析结果提示:CRP、APC、D-D均是重症创伤患者TIC发生的独立危险因素(P<0.05)。存活组CRP、APC、D-D水平均低于死亡组(P<0.05)。结论:急诊重症创伤患者TIC的发生与其体内CRP、APC、D-D三项指标水平的升高存在一定关系,且上述三项指标的持续升高会对TIC患者预后效果造成负面影响,值得深入研究。

Objective:To study the prognostic influencing factors and risk factors of trauma induced coagulopathy (TIC) in emergency patients with severe trauma.Method:A total of 80 patients with severe trauma complicated with TIC (study group) admitted to the emergency center of Minqing General Hospital from January 2018 to January 2020,and 80 patients with severe trauma but no TIC (control group) in the same period.After all patients were admitted to the hospital,all clinical data and information were improved.When the patients were transferred to ICU,blood samples of the external elbow vein were collected to detect the coagulation indicators,inflammation indicators and blood routine indicators.The coagulation,inflammation and blood routine indexes were compared between the two groups.The influencing factors of TIC were analyzed.According to the prognosis,the patients in the study group were divided into survival group and death group,and the blood routine indexes of survival group and death group were compared.Result:The levels of C-reactive protein (CRP),serum activated protein C (APC) and D-dimer (D-D) in the study group were higher than those in the control group (P<0.05),and the levels of fibrinogen (FIB),platelet count (PLT) and hemoglobin (Hb) were lower than those in the control group (P<0.05).Logistic regression analysis showed that CRP,APC and D-D were independent risk factors for the occurence of TIC in patients with severe trauma (P<0.05).CRP,APC and D-D levels in the survival group were lower than those in the death group (P<0.05).Conclusion:The occurrence of TIC in emergency patients with severe trauma is related to the increase of CRP,APC and D-D,and the continuous increase of the above three indicators will have a negative impact on the prognosis of TIC patients,which is worthy of in-depth study.