创伤性凝血病危险因素的系统评价

Risk factors for traumainduced coagulopathy:a systematic review

目的:系统评价创伤性凝血病(TIC)的危险因素。方法:计算机检索中国知网(CNKI)、万方数据库(WanFang Database)、维普(VIP)、中国生物医学文献数据库(CBM)、PubMed、EMbase、the Cochrane Library、Web of Science等数据库,收集创伤病人发生TIC危险因素的病例-对照研究、队列研究以及横断面研究,检索时限从建库至2021年3月。由2名研究者独立筛选文献并进行资料提取,对纳入研究进行偏倚分析评价后采用RevMan 5.3软件进行Meta分析。结果:共纳入19篇文献(20项研究),包括4 444名研究对象,涉及危险因素18个。Meta分析结果显示:GCS评分≤8分[OR=2.51,95%CI(1.99,3.18),P<0.000 01]、ISS评分高[OR=1.14,95%CI(1.04,1.25),P=0.004]、头颈部AIS评分高[OR=3.18,95%CI(1.74,5.81),P=0.000 2]、合并重型颅脑损伤[OR=2.01,95%(1.55,2.60),P<0.000 01]、合并蛛网膜下腔出血[OR=2.09,95%CI(1.52,2.86),P<0.000 01]、脑室出血[OR=2.68,95%CI(1.34,5.38),P=0.006]、硬膜下血肿[OR=3.08,95%CI(1.96,4.84),P<0.000 01]、CT中线移位[OR=2.72,95%CI(1.60,4.63),P=0.000 2]、收缩压<90 mmHg[OR=9.71,95%CI(4.11,22.96),P<0.000 01]、合并休克[OR=2.84,95%CI(1.78,4.54),P<0.000 1]、碱缺失(base deficit,BD)≥6 mmol/L[OR=3.26,95%CI(1.70,6.22),P=0.000 4]、低体温[OR=2.56,95%CI(1.11,5.91),P=0.03]、血小板减少[OR=1.03,95%CI(1.01,1.04),P=0.002]、低血红蛋白[OR=3.62,95%CI(1.74,7.52),P=0.000 6]与创伤病人TIC的发生相关。结论:当前证据表明,创伤严重程度(GCS评分≤8分、ISS评分、头颈部AIS评分)、颅脑损伤(合并重型颅脑损伤、蛛网膜下腔出血、脑室出血、硬膜下血肿、CT中线移位)、收缩压<90 mmHg、合并休克、剩余碱、低体温、血小板计数、血红蛋白等为创伤病人TIC发生的危险因素。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective:To systematically review the risk factors associated with trauma induced coagulopathy.Methods:Collect the case-control studies,cohort studies and cross-sectional studies on the risk factors of trauma induced coagulopathy were retrieved from CNKI,WanFang Database,VIP,CBM,PubMed,EMbase,Web of Science and the Cochrane Library database.The retrieval time was from inception to March,2021.Two reviewers independently screened literature,extracted data and evaluated the risk of bias of included studies.Then,Meta-analysis was performed by using RevMan 5.3 software.Results:A total of 19 articles(20 studies) were included,with a total of 4 444 patients,including 18 risk factors.The results of Meta-analysis showed that the combined effect of GCS score≤8[OR=2.51,95%CI(1.99,3.18),P<0.000 01],higher ISS score[OR=1.14,95%CI(1.04,1.25),P=0.004],chigher head AIS score[OR=3.18,95%CI(1.74,5.81),P=0.000 2],severe brain injury[OR=2.01,95%CI(1.55,2.60),P<0.000 01],combine subarachnoid hemorrhage[OR=2.09,95%CI(1.52,2.86),P<0.000 01],intraventricular hemorrhage[OR=2.68,95%CI(1.34,5.38),P=0.006],subdural hematoma[OR=3.08,95%CI(1.96,4.84),P<0.000 01],CT midline shift[OR=2.72,95%CI(1.60,4.63),P=0.000 2],systolic bloodpressure<90 mmHg[OR=9.71,95%CI(4.11,22.96),P<0.000 01],shock[OR=2.84,95%CI(1.78,4.54),P<0.000 1],base deficit(BD)≥6 mmol/L[OR=3.26,95%CI(1.70,6.22),P=0.000 4],hypothermia[OR=2.56,95%CI(1.11,5.91),P=0.03],platelet count[OR=1.03,95%CI(1.01,1.04),P=0.002],low hemoglobin[OR=3.62,95%CI(1.74,7.52),P=0.000 6] were statistically significant risk factors for trauma induced coagulopathy in trauma patients.Conclusion:Current evidence shows that the risk factors for trauma induced coagulopathy in trauma patients are severity of trauma(GCS score≤8,ISS score,head AIS),brain injury(severe brain injury,subarachnoid hemorrhage,intraventricular hemorrhage,subdural hematoma,CT midline shift),systolic bloodpressure<90 mmHg,shock,BD≥6 mmol/L,hypothermia,platelet count,low hemoglobin.Due to the limited quality and quantity of included studies,more high quality studies are needed to verify the above conclusions.