创伤患者继发急性创伤性凝血功能障碍的相关危险因素分析

Related risk factors for secondary acute traumatic coagulopathy in trauma patients

目的通过对创伤患者继发急性创伤性凝血功能障碍(ATC)的相关危险因素进行分析,以期为严重创伤患者早期急性凝血功能障碍预防、救治及预后改善等方面提供参考。方法回顾性收集苏州大学附属第一医院十梓街院区2020年1月1日至12月31日于急诊抢救室就诊后至急诊创伤病房住院的创伤患者临床资料,按照继发ATC临床诊断标准将创伤患者分为ATC组(继发ATC,n=35)与非ATC组(不伴ATC,n=147)。利用多因素logistic回归模型分析创伤患者继发ATC的影响因素。结果收集的182例创伤患者中,继发ATC的占19.2%,不伴发ATC的占80.8%。两组在年龄、损伤严重程度评分(ISS)、格拉斯哥昏迷评分(GCS)、创伤指数(TI)、体温、休克指数、血小板计数、血红蛋白、白蛋白、肌酐及首次输血时间>24 h方面差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄大、TI评分高、白蛋白水平低及首次输血时间>24 h是严重创伤患者继发ATC的独立危险因素(P<0.05)。结论年龄、TI评分、白蛋白及首次输血时间>24 h是严重创伤患者继发ATC的独立影响因素。应加强临床急诊工作中对于创伤患者的严重程度、伤者自身基础条件以及伤后早期干预措施的重视,从而降低严重创伤患者ATC的发生率,提高严重创伤患者救治率并改善其预后。

Objective To analyze the related risk factors of early acute traumatic coagulopathy(ATC)secondary to trauma in order to provide references for the prevention,treatment,and prognosis of ATC in patients with severe trauma.Methods The clinical data of trauma patients hospitalized in the First Affiliated Hospital of Soochow University from January 1 to December 31,2020 were retrospectively collected.The trauma patients were divided into ACT group(secondary ACT,n=35)and NO-ATC group(without ATC,n=147)according to the clinical diagnosis criteria of acute post-traumatic coagulopathy.Multivariate logistic regression model was used to analyze the influencing factors of secondary ATC in trauma patients.Results Among 182 trauma patients collected,19.2%were secondary to ATC and 80.8%were not associated with ATC.There were statistical differences in age,injury severity score(ISS),Glasgow coma scale(GCS),trauma index(TI),body temperature,shock index(SI),platelet count,hemoglobin,albumin,creatinine and the time of first transfusion(more than 24 h)between two groups(P<0.05).Multivariate logistic regression analysis showed that older age,higher TI score,lower albumin level and the time of first blood transfusion(more than 24 hours)were the independent risk factors of secondary ATC in patients with severe trauma(P<0.05).Conclusion Age,TI score,albumin and time of first blood transfusion>24 hours were independent influencing factors of secondary ATC in patients with severe trauma.The more attention should be paid to the early intervention measures for the patients with the severity of trauma,so as to reduce the incidence of ATC and to improve the rescue rate and the prognosis of severe trauma patients in clinical emergency work.