严重多发伤患者血浆F1＋2、D-二聚体水平的变化及与弥散性血管内凝血的关系  

Changes of plasma F1 ＋ 2, D-dimer levels in multiple trauma patients and their relations with disseminated intravascular coagulation

作　　者：朱渝军[1] 黄显凯[1] 

机构地区：[1]第三军医大学附属大坪医院野战外科研究所全军战创伤中心,重庆400042

出　　处：《中华创伤杂志》2008年第10期837-840,共4页Chinese Journal of Trauma

摘　　要：目的探讨严重多发伤患者血浆凝血酶原片段（F1＋2）、D-二聚体水平变化及与创伤后弥散性血管内凝血（DIC）之间的关系。方法将66例多发伤患者分为轻伤组（ISS〈16分）21例和重伤组（ISS≥16分）45例，再把重伤患者分为并发DIC组（12例）与未并发DIC组（33例）。另10例健康人设为正常对照组。正常对照组采外周静脉血1次，其余组分别于伤后1、3、7d空腹采集外周静脉血，应用ELISA方法测定血浆F1＋2浓度，全自动乳胶微粒增强免疫比浊分析方法测定血浆D-二聚体浓度。结果轻伤与重伤组血浆F1＋2、D-二聚体水平伤后均明显高于正常对照组，且重伤组又明显高于轻伤组。非DIC组伤后F1＋2、D-二聚体水平逐渐降低，DIC组F1＋2、D-二聚体水平持续升高并显著高于非DIC组。血浆F1＋2、D-二聚体水平在伤后1、3、7d均呈明显的正相关。结论创伤后急性期F1＋2、D-二聚体水平的升高程度不仅与创伤严重程度有关，而且与创伤后DIC的发生密切相关。因此，测定严重多发伤患者急性期外周血浆F1＋2、D-二聚体水平变化对早期预测创伤后DIC的发生具有一定价值。Objective To observe changes of plasma thrombinogen segment 1 ＋ 2 （F1 ＋ 2 ） and D-dimer （D-D） in multiple trauma patients and explore their relations with traumatic disseminated intravascular coagulation （DIC）. Methods A total of 66 multiple trauma patients were divided into minor injury group （ISS 〈 16 points, 21 patients ） and severe multiple trauma group （ISS≥ 16 points, 45 patients）. Then, severe muhiple trauma group were divided into DIC group （12 patients） and non-DIC group （33 patients）. Another 10 healthy persons were served as control group. Venous blood was collected once in the control group and that collected from other groups at days 1, 3 and 7 after injury. The FI ＋ 2 concentration was determined with ELISA, and the D-D concentration was measured by automated latex enhanced immunoassay. Results The F1 ＋ 2 and D-D levels in the minor injury group and sever multiple trauma group were both higher than that of the control group. In the meantime, the F1 ＋ 2 and D-D levels in severe injury group were remarkably higher than that in the minor injury group. The plasma F1 ＋ 2 and D-D levels were elevated continuously in traumatic DIC group and remarkably higher than that in the non-DIC group, in which the plasma F1 ＋ 2 and D-D levels gradually declined. Plasma F1 ＋ 2 and D-D levels had significantly positive correlations at days 1, 3 and 7 after injury. Conclusions Higher levels of F1 ＋ 2 and D-D at acute stage is not only relevant to the injury severity, but also closely to the occurrence of traumatic DIC after injury. Detection of plasma F1 ＋ 2 and D-D levels may play an important role in early prediction of DIC.

关 键 词：多处创伤 弥漫性血管内凝血 凝血酶原片段1+2 D-二聚体 

分 类 号：R64[医药卫生—外科学] R554.8[医药卫生—临床医学]