高原爆炸伤后凝血指标的变化特点及临床意义

The characteristics and clinical significance of changes in coagulation indicators afterhigh-altitude explosive injury

目的研究高原爆炸伤后凝血指标的变化特点,探索其临床意义。方法选择13头高原绵羊作为研究对象,按随机数字表法进行编号,进行凝血指标采集后,行炮弹炸伤进行造模,伤后给予常规处理,分别于爆炸后1h、爆炸后6~8h、爆炸后24h、爆炸后48h、爆炸后72h。采静脉血测定凝血指标(PT、APTT、TT、FIB、D-Dimer)。结果①PT指标变化,在爆炸后6~8h显著低于爆炸前(P<0.05),整体呈先下降后上升趋势;②APTT指标变化,在爆炸后24h显著高于爆炸前(P<0.05),整体呈先上升后下降趋势;③FIB指标变化,在爆炸后48h显著高于爆炸前(P<0.01),爆炸后72h处于最高(P<0.05),整体呈上升趋势;④D-Dimer指标变化,在爆炸后72h显著高于爆炸前(P<0.05),整体呈上升趋势;⑤TT指标变化,在爆炸后的各个时间点与爆炸前相比无统计学意义(P>0.05)。结论高原爆炸伤后机体处于高凝状态,动态观察凝血指标的变化,可为该地区的抗凝药物的合理使用及改善患者的预后提供一定的理论依据。

Objective:To study the characteristics of changes in coagulation indexes after blast injury at high altitude,and to explore its clinical significance.Methods:A total of 13 plateau sheep were selected as the research subjects and numbered according to the random number table method.After collecting the coagulation indicators,the sheep were injured by shell blast to establish the model.Venous blood samples were collected to measure coagulation indexes(PT,APTT,TT,FIB,D-Dimer).Results:1.The PT index at 6-8h after explosion was significantly lower than that before explosion(P<0.05),and the overall trend was first decreased and then increased.(2)The change of APTT index at 24h after explosion was significantly higher than that before explosion(P<0.05),showing a trend of first increasing and then decreasing;(3)The change of FIB index was signifi-cantly higher at 48h after explosion than that before explosion(P<0.01),and was the highest at 72h after explosion(P<0.05),showing an overall upward trend;(4)The change of D-Dimer index at 72 hours after explosion was significantly higher than that before explosion(P<0.05),showing an overall upward trend;(5)The changes of TT index at each time point after the explosion were not statistically significant compared with those before the explosion(P>0.05).Conclusion:The body is in a hypercoagula-ble state after blast injury at high altitude.The dynamic observation of the changes of coagulation indexes can provide certain theoretical basis for the rational use of anticoagulant drugs and the improvement of the prognosis of patients in this area.