老年严重多发伤患者凝血功能障碍发病及危险因素分析

Analysis on the onset and risk factors of coagulation dysfunction in elderly patients with severe multiple trauma

目的:探讨老年严重多发伤患者凝血功能障碍发病特点及危险因素。方法:对我院2019年3月~2021年12月143例老年严重多发伤患者的临床资料进行回顾性分析,根据凝血功能障碍发病情况分为凝血功能障碍组(n=22)及非凝血功能障碍组(n=121),采用单因素及多因素Logistic分析影响老年严重多发伤患者凝血功能障碍发病的危险因素。结果:143例老年严重多发伤患者中,22例合并凝血功能障碍发病,发生率为15.38%(22/143);凝血功能障碍组ISS评分≥30分、GCS评分<8分、酸中毒、MODS、低体温所占比例及输血量均高于非凝血功能障碍组;凝血功能障碍组PLT、HGB低于非凝血功能障碍组,PT>18s、APTT>60s所占比例均高于非凝血功能障碍组;多因素Logistic回归分析显示,ISS评分≥30分、GCS评分<8分、酸中毒、MODS、低体温、PLT<78.25×10^(9)/L、HGB<93.34g/L、PT>18s、APTT>60s均为老年严重多发伤患者凝血功能障碍发病的独立危险因素。结论:ISS评分、GCS评分、酸中毒、低体温、PLT、HGB、PT、APTT与老年严重多发伤患者凝血功能障碍发病密切相关,临床需重视上述因素并给予针对性治疗,以降低凝血功能障碍发病。

Objective To explore the onset characteristics and risk factors of coagulation dysfunction in elderly patients with severe multiple trauma.Methods The clinical data of 143 elderly patients with severe multiple trauma in the hospital were retrospectively analyzed between March 2019 and December 2021.According to presence or absence of coagulation dysfunction,they were divided into dysfunction group (n=22) and non-dysfunction group (n=121).The risk factors of coagulation dysfunction were analyzed by univariate and multivariate Logistic analysis.Results In the 143 elderly patients with severe multiple trauma,there were 22 cases with coagulation dysfunction,with incidence of 15.38% (22/143).The proportions of cases with ISS score ≥30 points,GCS score <8 points,acidosis,multiple organ dysfunction syndrome (MODS) and hypothermia,and blood transfusion volume in dysfunction group were higher than those in non-dysfunction group.PLT and HGB in dysfunction group were lower than those in non-dysfunction group,while proportions of cases with PT >18s and APTT >60s were higher than those in non-dysfunction group.Multivariate Logistic regression analysis showed that ISS score ≥30 points,GCS score <8 points,acidosis,MODS,hypothermia,PLT <78.25×10^(9)/L,HGB <93.34g/L,PT >18s and APTT >60s were all independent risk factors of coagulation dysfunction in elderly patients with severe multiple trauma.Conclusion ISS score,GCS score,acidosis,hypothermia,PLT,HGB,PT and APTT are closely related to the onset of coagulation dysfunction in elderly patients with severe multiple trauma.Clinically,attentions should be paid to the above factors and targeted treatment should be given to reduce the incidence of coagulation dysfunction.